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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date L-/U!i U (p <br />I i <br />To:San Joaquin County <br />Department of Public Works <br />Po r;g,-G'ih <61t:c.A-n ( <br />(Applicant Name) <br />YWb {AJe>J-l_rU(Mailing Address) <br />21-u feb'"c.J8 q '57 tl'1(City,State,Zip Code) <br />L-jn)c !>I (p-17 v 1(Area Code -Telephone Number) <br />OFFICE USE ONLY <br />J08#7J<XJSJ-&REF# <br />APN .,CR# <br />EXP.DATE ejJ/I(",., <br />VALID 4/iihTO elt(;h DRIVEWAYS: <br />STREET 't!kd;.e ,eO,I • <br />AREA '1J',4Cef QUAD ~, <br />TYPE f3;a:#ae'• <br />FORMS ~¥J!J//.?n,Ve.1d MA;1;r <br />NOTES <br />Sketch (Detailed plans may be submitted) <br />S£.G J4-'r-rt+LI+6 ~5k&7ut , <br />-I--. <br />41.41 J(.t{l subject to pavement cuts shall reeeiv:an(1)-inch asphalt concrete overlay from the centerline (or laneline)to the edeg of the travel way as per the San Joaquin <br />County Trench GlJt poliet if ,the pavement is disf~rbe~on bothsidesofthecenterlineoradjacentlane),then the entIreroadway(or affected lanes)shall be resurfqced.Contractor <br />shall grind and overlay within 10 working days of per~a!1enttrenchpaving.Shoulder areas shall be brought up to flnlshgradeasdirectedbytheCounty. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the ~l)~side of tA-J.el,vN"approximately qi..e ')Qnile &,y <br />of (~(kll "lJ ,v.<;,by pertor ng the following work (description of work):10 t......'J,4Ut'vt ......•L-c.k ~ <br />Work will commence on or about for approximately days. <br />I,the undersign~".eertift that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work describ above i 7accordance with the rules and regulations of San Joaquin County and subject to Inspection and approval. <br />Signature of-Applican0jt <br />E.\f'UB-SV.wKlMASTERPS\ENCROACHMENT PERMITAPPlICATION.DOC (OlIll8) <br />'-t IN/!(.r Date