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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 01 MARCH 2010 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 11049< REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> ADVANCED GEOENVIRONMENT.AL, INC. VALID Q.3 Q TO / p DRIVEWAYS: <br /> (Applicant Name) STREET "D ' <br /> AREA - p, / QUAD ' <br /> 837 SHAW ROAD TYPE ,?WAo6,,Aj�, AP.4 '„.,,Li AWI <br /> (Mailing Address) FORMS r <br /> STOCKTON, CA, 95215 NOTES <br /> I <br /> (City, State,Zip Code) <br /> 209 467 - 1006 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> I � <br /> I � <br /> � I <br /> I <br /> i <br /> I <br /> i <br /> I� <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAST AND WEST side of THORNTON ROAD approximately 200 FEET feet/mile SOUTH <br /> Of STOCKTON STREET AND 150 FEET SOUTH,OF MOKELUMNE ROAD , by performing the following work(description of work): <br /> MONITORING WELL DESTRUCTION AND REMOVALS : MW-2, MW-6 AND MW-7. <br /> Work will commence on or about_ 15 MARCH 2010 for approximately 3 TO s 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 /> MARCH 2 010 <br /> Signature of Applicant-Title Date <br /> E2PUBSV WKMMASTER.PSENCROACHMENT PERMIT APPLICATION COC !0110W <br />