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11/16/2009 10:54 FAX 17077890414 ERI Petaluma 16002/002 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date November 11, 2009 OFFICE USE ONLY <br /> To: San Joaquin County Joe# _//ppp�' REF# <br /> Department of Public Works APN CR# <br /> TE <br /> Environmental Resolutions "DA '�''� <br /> (Applicant Name VALID DRIVEWAYS: <br /> TO _a• •i/D <br /> STREET _ff►e1/ fV OAOx 5q(,E <br /> 641 North McDowell Blvd. AREA W-A_,5 QUAD <br /> TYPE <br /> (Mailing Address) FORMS Z <br /> Petaluma, CA 94954 NOTES <br /> (City,State,Zip Code) <br /> (707) 766.2000 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitbed) <br /> See attached site map and photo for proposed groundwater monitoring well. locations. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Cou*Kighway Right-of--Way on <br /> the Eaet side of Hwy. 99 Frontage Road approximatety 10 _ _feet/mile south <br /> of the intersection of S. Calimayrna and Hwy 99 Frontage Rd. ,by performing the following work(description of work): <br /> Two groundwater monitoring wells will be drilled to approximately 140 feet <br /> using a mud rotary drilling rig. Monitoring wells will be constructed of 2-inch <br /> diameter PVC casing and sealed with a water tight seal <br /> Work will commence on or about I before anuary for approximately 5 days. <br /> i,the unders=ApWc-ant <br /> er of the respective property,or am qualified to represent the owner and agree to do the <br /> work describith the rules and regulations of Sart Joaquin County and subject to Inspection and approval. <br /> ( 1 �� 09 <br /> Slae Date <br /> �wasr.+ewsrao.sirr4f�whKalou.00c mm� <br />