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PLEASE PRINT: <br />Date <br />To: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />10/18/2019 <br />San Joaquin County <br />Department of Public Works <br />ATT VCC/PERMITS DESK <br />(Applicant Name) <br />OLIVE AVE <br />(Mailing Address) <br />FRESNO, CA. 93727 <br />(City, State, Zip Code) <br />559-454-4900 <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />PERMIT PLANS AND TRAFFIC CONTROL ATTACHED <br />Debbie Sneed <br />(559) 739-6646 <br />A01PXPC 850 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST side of NEWTON RD approximately 2,565 FT feet/mile NORTH <br />of CHEROKEE RD by performing the following work (description of work): <br />SHOULDER CLOSURE TO ACCESS SIDEWALK BOX JUST N/O DRIVEWAY TO 3732 NEWTON RD <br />Work will commence on or about 11/15/19 _� for approximately <br />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 with the rules and regulations of San Joaquin County and subject'to inspection and approval. <br />Engineering. <br />Administrator <br />Signature of Applic�fif -Title <br />U.10EIITRALSER4ICESICLERICALNUBSV.VJ:CHASTER.PSIENCROACH'dLMTPERMITAPPLICATI011.000 (09113) <br />10/18/2019 <br />Date <br />OFFICE USE ONLY <br />JOB# <br />00 7!' REF# <br />APN <br />CR # <br />EXP. DATE <br />VALID <br />TO DRIVEWAYS: <br />STREET <br />AREA <br />QUAD <br />TYPE <br />FORMS <br />NOTES <br />PERMIT PLANS AND TRAFFIC CONTROL ATTACHED <br />Debbie Sneed <br />(559) 739-6646 <br />A01PXPC 850 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EAST side of NEWTON RD approximately 2,565 FT feet/mile NORTH <br />of CHEROKEE RD by performing the following work (description of work): <br />SHOULDER CLOSURE TO ACCESS SIDEWALK BOX JUST N/O DRIVEWAY TO 3732 NEWTON RD <br />Work will commence on or about 11/15/19 _� for approximately <br />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 with the rules and regulations of San Joaquin County and subject'to inspection and approval. <br />Engineering. <br />Administrator <br />Signature of Applic�fif -Title <br />U.10EIITRALSER4ICESICLERICALNUBSV.VJ:CHASTER.PSIENCROACH'dLMTPERMITAPPLICATI011.000 (09113) <br />10/18/2019 <br />Date <br />