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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: OFFICE USE ONLY <br /> JOB * //b0sREF# <br /> Date—August 14, 1998 APN CRV# <br /> EXP.DATE / 9 <br /> VALI?Y2 TO DRIVEWAYS: <br /> To:San Joaquin County Highway Department. STREETGoZoe3.�G�rB' <br /> slerra Pacific Groundwater Consultants, Inc AREA Sr'C// QUAD <br /> (Applicant Name) TYPE /✓��/✓/To Ki�/L Gr��C <br /> FORMS ss/w Ad '-C7--Z. e� <br /> 4911 Windplay Drive Suite 4 NOTE <br /> (Mailing Address) <br /> EI Dorado Hills, Calif. 95762 <br /> (City,State Zip Code) <br /> (916) 933-1468 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed Plans may be submitted) <br /> SEE ATTACHED WORKPLAN <br /> The undersigned hereby applies for permission to excavate,construct and /or otherwise encroach on County <br /> Highway Ri t-of-Way on the west side of Golden Gate Avenue ,approximately <br /> 150 UecNirsiie north of John Street ,by performing <br /> following work:(description of work): Drill boring and install 2-inch diameter PVC groundwater <br /> monitoring well to an approxmate depth of 85 feet, with locking well cap and traffic-rated Christy Box <br /> completion flush with existing street pavement. <br /> Work will commence on or about /D T2 Of v for approximately —!—days. <br /> I the undersigned certify that I am the owner of the respective property,or am qualified to represent the owner,and <br /> agree to do the work described above in accordance with the rules,regulations of San Joaquin County and submit i <br /> to inspection and approval. <br /> 1 <br /> m 19(7, <br /> SlUTIATUM0 APPLICANT-TITLE kDATj <br />