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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5/2012020 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 110005 REF# <br /> Department of PubIc Works APN CR# <br /> KeNn BernardEXR DATE 911affo <br /> VALID 7/14 020 TO 9/1/2020 DRIVEWAYS: <br /> (Applicant Name) STREET welly Rd <br /> 5296 Harvest Lake Drive TYPE <br /> Tracy QUAD SW <br /> TYPE Borings <br /> (Mailing Address) FORMS SSWW,R-29 <br /> Loveland,Colorado 80538 NOTES <br /> (City,State,Zip Code) <br /> 303.261.2982 <br /> (Area Code LTelephone Number) <br /> kevin.henrantl@nuVlen.com <br /> (Email Address) <br /> Sketch(Delalled plans may be submitted) <br /> see Attached <br /> The undersigned hereby apples for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way <br /> ?,n the ytl n of wof South Welty Road approximately 650 feet north of South Highway 33,by pedorming the following work <br /> — - Two existed monitpH els!MW 5 and MW 87 will be properly abandoned and unplaced with new wells.MW 5R and MW-8R are located alone <br /> the eastern side of South Welty Road approximately 920 and 650 feet nnM of South Hiphwey 33 respectimly. <br /> Work will commence on or after July 6,2020 for approximately three 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 deserted above In accordance with the roles and regulations of San Joaquin County and subject to inspection and approval. <br /> Aeaya6 a June 3,2020 <br /> Signature of Appricant•Tilde Date <br />