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t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date lo/7=13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# PwP-1 11 ,5' REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I-LS-zo 13 <br /> Apex Envirotech,Inc. VALID 0- 0--2-43TO 11^LS DRIVEWAYS: <br /> (Applicant Name) STREET C-Cs.N-e,"'(Yt,e ((ZZa, <br /> AREA \b�. QUAD ' <br /> 11244 Pyrites Way TYPE 211 01 G <br /> (Mailing Address) FORMS S S/ <br /> NOTES <br /> Gold River,CA 95670 <br /> (City,State,Zip Code) <br /> 916-851-0174 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached Figures <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the north and south side of Lone Tree Road approximately 0-25 miles feet/mile east <br /> of the intersection of Campbell road and Lone Tree Road ,by performing the following work(description of work): <br /> Apex plans to advance four soil borings(SB-1 through SB-4)on the north side of Lone Tree Road and one soil boring(SB-5) <br /> on the south side of Ione tree road in the shoulders adjacent to the property lines.approximately 10 feet from the fog line. Each <br /> soil boring will be advanced with a small geoprobe drill rig and the locations have been selected based on the location of the <br /> previous spill at this location. I have included with this application the proposed workplan and the approval letter from the <br /> Regional Water Board. <br /> Work will commence on or about 1 011 7/201 3 for approximately 2 days. <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1018/13 <br /> Signature of Applicant-Title Date <br /> E.VUBSY.WKMSTERPSIENCROACHMEMTPERMITAPRICATIOH.DOC(OWB) <br />