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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date December 4, 2017 <br />To: San Joaquin County <br />Department of Public Works <br />William B. Lopez (Geo -Logic Associates) <br />(Applicant Name) <br />11415 West Bernardo Court, Suite 200 <br />(Mailing Address) <br />San Diego, CA, 92127 <br />(City, State, Zip Code) <br />(858) 451-1136 <br />(Area Code - Telephone Number) <br />(Email Ad cess) <br />Sketch (Detailed plans may be submitted) <br />JOB # <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />I�OQO S REF# <br />CR# <br />3 -1 - (� <br />- ( TO 3- (- /8 DRIVEWAYS: <br />pt V-/, <br />/c lJ7n QUAD_ <br />i3rlvf� <br />The flaggers and lane closure will be in place 24 hours a day. The lane closure will begin the day the <br />drilling equipment is set up and will end the day that the drilling equipment is removed. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the East side of Santa Ana way approximately 1900 feet feet/mile South <br />of E. Mariposa Road Stockton, CA , by performing the following work (description of work): <br />Drill and construct 2 (two groundwater monitoring wells AMW-35S and AMW-35 <br />Work will commence on or after January8, 2018 for approximately 27 dal <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 des ibed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />1 A I " V December 4, 2017 <br />Signature of Appli nt - Title Date <br />