Laserfiche WebLink
,. <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date '-II I'i II (,, <br />To:San Joaquin County <br />Department of Public Works <br />Ptic!(!"L"54j r £7ke-Mr(Applicant Name) <br />4<>41:>,Wr<l--Ie tU(Mailing Address) <br />~){jc..+v-ell!q':;2-0 tf <br />(City,State,Zip Code) <br />46Sc 3j(r!7(P -; <br />(Area Code.Telephone Number) <br />OFFICE USE ONLY <br />JOB#13o()6J.,'lP REF# <br />APN CR# <br />EXP,DATE e/if', <br />VALID ~4!ld'T 8/iJ1!tb DRIVEWAYS: <br />STREET r)/II()i11;4 1Jv6.• <br />AREA ~.k*"'ON QUAD M , <br />TYPE ~ur:a .FORMS <br />NOTES <br />w/1/';;z1;jie~dt1Y1Z/bt <br />Sketch (D'etailed plans may be submitted) <br />Sf-J:-e.m-rt4c.flt£.!)S~t3~t.-I <br />1-1151.7L'l V.subje,et to paverr"tent cuts shall lee-elve an .(i)-inch asphalt concrete"overlay from-the centerline (or Loneline)to the edeg of the trav'st way as per t~€!~an JoaquinCounfyTrenchCl-lf Pollcy.!f the pavement IS dIsturbed on bothsidesofthecenterline(or adjacent lane),then the el]tireroqdway(or affected lones)sholl be resurfaced.Contractor-. <br />shan g:rind and overlay within 10 working d.ays of pern;0!1enttrenchpaving.ShouLder areas shall be brought up to fInish <br />grade os <directed by the County. <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 {A.J,:5>"••0 IN'tLJv.-approxim'ately'5'o,}-,emile W <br />of &:Ie $.fliihl."by performing the following work (description of work): <br />Work will commence on or about for approximateiy 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 describe e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />4/t4,/fL ,Date <br />E:\PU8~V.WK\MASTERPS\ENCROACliMENT PERMIT APPUCATlON,DOC (ll1JG6) <br />.i