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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date d1/14//GeIj <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />{Jlid R,&;};r .&iCeMr <br />(Applicant Name) <br />4 ('Nt>tAJp >.h c /t,J <br />(Mailing Address) <br />s-l7\fJc..~til!q<;Lo tf <br />(City,State,Zip Code) <br />/joy..3/(0 -I 7f£,1 <br />(Area Code-Telephone Number) <br />JOB #'/Ju&5J-& <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />Sketch (Detailed plans may be submitted)- <br />5F-f-e ~1/lC-1It£1)'SI::.{3'/l:.-1-/ <br />:,Il..[(pll'l - <br />_subjed to pavement cuts shall ,eceiv~an(l)-inch asphalt concrete overlay from-the centerlll1e (or Lane <br />line.)to the edeg of fhe travel way as per.t~e ~an JoaquinCountyTrenchC\J+Policy.If the pavement is dlsfurbe~on bothsidesofthecenterline(or adjacent lane),then the entIreroq.dway (or affected lanes)shall be restlt:"faced.Contractor, <br />shoJI g'rind and overlay within 10 working days of permanenttrenchpaving.Shoulder area's sholl be brought up to finishgradeasdirectedbytheCounty. <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 10inspection and approval. <br />E.\PUB-SV.WKIMIlSTERPSIENCROACHMENT PERMIT IIPPLICATION.OOG (01IDB) <br />'-1 !f-il;{~r Date