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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 07-7-2014 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> Advanced GeoEnvironmental EAP. DATE y- - <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET Ao illdc ie Ai/ <br /> AREA Fr7r,k}nyi OUAD <br /> 837 Shaw Road TYPE <br /> (Mailing Address) FORMS S.5IW JAI <br /> Stockton, CA 95215 NOTES <br /> (City,State,Zip Code) <br /> 209 467 1006 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See attached map for location and parking plan closure. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the I _side of Robindale Avenue approximately 20 feet/mile north <br /> of O Wilson Way _, by performing the following work(description of work): <br /> 2)West side of Sanguinetti Lane, 150 feet south of Robindale Avenue, 3)West side of North Wilson Way 150 feet north <br /> of center line of Robindale Avenue. <br /> Drilling of groundwater monitoring wells for final destruction in accordance with SJ Co well code, <br /> see attached map for locations. <br /> Monitoring well destructions for property at 2662 North Wilson Way, Stockton, CA. <br /> Work will commence on or about 21 JLJLY 2014 for approximately TWO-THREE 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 /> W, 07/7/2014 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKMSTER.PSIENCROACHMENTPERMTAPPLICATION.DOC (01108) <br />