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APPLICATION FOR ENCROACHMENT PERMIT <br /> AW Date .7anuar 19H9___ <br /> To the San Joaquin County <br /> Highway Department <br /> Gentlemen <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County High%ay right of way by performing the following work <br /> Install a ground water monitoring well(s) <br /> (Applicant will describe here fully what he wishes to do using reverse side if necessary) <br /> A mobil drilling rig using 1C" hollow stem augurs will drill 10" diameter boxing($ ) to <br /> 65 feet below the surface, 4" ground water monitoring uell(s ) will be constructed fro" <br /> tre boring(s) . Grout inspection will be performed by San Joaquin Courty Health. The <br /> drilling will be performed under a drilling permit obtained from San Joaquin County Health. <br /> Prior to drilling underground alert will locate all underground utilities (See Figure 1 and enclosed <br /> Space for sketch Submit detailed plans if available <br /> want air/permit packet). <br /> � CL) s <br /> c— �4 <br /> TI <br /> T .w <br /> _ r <br /> � <br /> \ <br /> r <br /> m <br /> G' <br /> On County Highway Countv easement south side of Douglas Road and west of Pacific Avenue <br /> (Applicant will state here accurately the location of the work he desires to do) <br /> and agrees to do the work in accordance with your rules and regulations and subject to your inspection <br /> and approval <br /> Signature o Applicant George L. Converse <br /> Western Geo-Engineers <br /> (916) 662-4541 <br /> Phone Number <br /> 1386 E. Beamer Street <br /> Woodland, CA 95695 <br /> Post Office Address <br /> Permit issued —4 0—L'U <br /> (D PW-24 I9/841 <br />