Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date April 13, 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 4=_1— <br /> California <br /> 1California Dept. of Transportation - D10 VALID T /Z DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA -; OCVtU&AD Al,LV <br /> 1976 E. Marfan Luther King Jr. Blvd. TYPE -I_A09f11514-4_GIk72091- <br /> j/ILP� i <br /> (Mailing Address) FORMS <br /> NOTES <br /> Stockton, CA 95205 <br /> (City,State,Zip Code) <br /> i <br /> Jasmine Noriega - (209) 948=7076 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See maps attached. Detour proposed on Walnut Grove Road. <br /> 1 <br /> No in ground signs will be placed on the detour <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately - feet/mile j <br /> Of by performing the following work(description of work): I <br /> Full closure of the Route 12 on Tuesday, June 5, Wednesday June 6 and Thursday June 7 2012 <br /> from 7:00am -4:00pm daily. Full closure required.to perform necessary maintenance work on existing <br /> distressed pavement. Work will include repaving, shoulder maintenance, vegetation control, new <br /> pavement markings and signs. <br /> Work will commence on or about Tuesday, rn . ?012 for approximately three days. <br /> I,the undersigned,certify that I am the ownE!r of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 4/13/12 <br /> i nature of Applicant-Title -1`r 5 pa �n 5��r Date i <br /> UPUMMKIMAB V NCROAC11109PIRWAPPLICATIONDOC(008) <br /> I <br /> f <br />