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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4/24/2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Rubik Environmental VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA v„r f QUAD <br /> 320 Flint Street TYPE - <br /> (Mailing Address) FORMS <br /> NOTES <br /> Reno,Nevada 89501 <br /> (City,State,Zip Code) <br /> (775) 622-0857 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See Figure for monitoring well locations. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the West side of Golden Gate Avenue approximately 66 ee ile North <br /> of John Street Stockton , by performing the following work(description of work): <br /> Uncover a paved over monitoirng well and setting a new well box at the new grade The area surroundingthe he new <br /> well box will e hot patched, <br /> Work will commence on or about May 12,2014 for approximately 1 days. <br /> I,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 /> 4/24/2014 <br /> Signature of Applicant-Title Date <br /> Stephen A. Meninger, PG Senior Geologist <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />