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I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date February 18,2010 OFFICE USE ONLY <br /> To: San Joaquin County JOB# jjQj REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE t zo)& <br /> ATC Associates for Jay Mcllrath VALID !r Loio TO r LMo DRIVEWAYS: <br /> (Applicant Name) STREET MAIA 5}• <br /> AREA S} QUAD/ <br /> 1117 Lone Palm Ave Suite 201 TYPE , o m w4( C rofou uaa <br /> (Mailing Address) FORMS w J <br /> NOTES <br /> Modesto, Ca 95351 <br /> (City,State,Zip Code) <br /> (209)579-2221 <br /> (Area Code-Telephone Number) �(f( <br /> Sketch(Detailed plans may be submitted) proposed 4 <br /> ` MV40A / 4 <br /> location of /' I <br /> \ c r monitoring <br /> Uusc a d <br /> 1 G MW <br /> 1000 <br /> 6 to <br /> MWIA 9Sa)es st S 00 y. <br /> Eew�c i Ma 95 5 <br /> P <br /> �\ uwre 0 \209 g31 033 <br /> YAGWT LOT <br /> 1 <br /> The undersigned hereby applies for permission to excavate,construct andlcr otherwise encroach.on County Hiohwav Riaht-of-Way on <br /> the south side of 4126 E. Main Street approximately 15 feet <br /> of the intersection of E. Main with Annabelle Court by performing the following work(description of work): <br /> A TC Associates la under contract to conduct a oroundwater investicration the result of an Underground Storage Tank <br /> Leak at 4075 E Main in Stockton Ca. This investigation is being directed by the San Joaquin County Enwronmental j <br /> Health Department Part of the current phase of this investigation involves installing a monitoring well in the sidewalk m <br /> coup ng -or-way in fon o o Sales 4126 E. Main St Stockton, <br /> CA 9521 b. <br /> Work will commence on or about March 1 2010(subtest to permittina) for approximately 3 Sys. <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 /> I <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Michael D. Sonke Project Manager ATC Assoc February 18,2010 <br /> Signature of Applicant-Title Date <br /> E>T18NwgMb�Fl+YotEr4vou'+uv+i PcaMrwauwltMl.om P1.m1 <br /> i <br /> I <br /> I <br />