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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date April 25,2012 OFFICE USE ONLY <br /> To'. San Joaquin County _ 'JOB# 1/0010 ' REF# <br /> Department of Public Works 'APN CR# <br /> EXP.DATE 2. <br /> Cardno ERI <br /> VALID /" .t- 4 !S' DRIVEWAYS: <br /> (Applicant:Name) 'STREET Gr44A « <br /> AREAAw <br /> 601 North McDowell Blvd. TYPE _� troY <br /> i (Mailing Address) FORMS <br /> NOTES <br /> Petaluma, CA 94954 <br /> State,Zi Code <br /> (City, ZipCode) <br /> (707) 766.2000 - <br /> (Area Code Telephone Number) <br /> Sketch(Detailed plans may be submitfed� _ <br /> See attached site map and photo for groundwater monitoring well'locations,. <br /> The undersigned hereby applies for permission to excayate,construct ano/ar otherwise encroach"..on County Highway Flight=of•Way,fln_ <br /> the Ease side of Hwy. -99 P'ronta a Road;--:� -1'0 South <br /> approximately. feellmile <br /> �f the. intersection an a� e:.Ca1fn ayrna arid-.r;�� �� Frontage �a : bjr perfarr�+r g the.foflowing'work{descript+ori'df w6rk):. <br /> Destruction :of 'three muni:toring we'-lls._.(r�9Yi!�.,° NtY1� & M[+1101 by pressure",grotiting an.cl: <br /> and over-drill too 5 feet, <br /> Work will commence on or about J. u Y .2012 <br /> for approximately 2-3 business 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 wilh the rules and regulations of San Joaquin-County and subject to inspection and approval. <br /> SJ' t rt:of Applicant-T' Ie Date <br /> f . <br /> [vtx vrx., fu ...r rk an.unNnw r-, <br />