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I <br />APPLlCA nON FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 05/06/2016 OFFICE USE ONLY <br />• <br />• <br />DRIVEWAYS: <br />JOB #13005'6-ta REF # <br />APN CR# <br />EXP.DATE 8{tU/P <br />VALID 'bollia 'TO spIlt, <br />STREET LA&N ,27). <br />AREA -raAt:.'(QUAD ~~_W . <br />TYPE ~~.: <br />FORMS SS/MAiM7,-t7t'"c:4.cvll4~ <br />NOTES <br />San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Addtess) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />408-316-1767 <br />(Area Code.Telephone Number) <br />To: <br />Sketch (Detailed plans may be submitted) <br />-_.__.....--~.-.__..•..__.-_._.._.-.-SEE AIT ACHED SKETCH _..•..._._...__...•__ <br />W.L","vc....'"t.).subject to pavement cuts shall receive on <br />(1)inch asphalt concrete overlay from the centerline (or ~ane <br />line)to the edeg of fhe travel way as per t.he ~an :JoaquinCountyTrenchCutPolicy.If the pavement IS dlsfurbe~on bothsidesofthecenterline{or adjacent lone),then the enflre , <br />roadway (or affected lanes)shall be resurfaced..Contractor <br />shall grind and overJay within 10 working days of per~a~enttrenchpaving.Shoulder areas shall be brought up to finIsh <br />grade as 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 SOl ITH side of 10988 W I ARCH RD approximately 1920'feet/mile WEST <br />of N TRACY BLVD TRACY,by performing the following work (description of work): <br />DIGGING liP S'xS'OF ASPHAIII T FOR A SERVICE REPI ACEMENT TO 10988 W I ARCH RD <br />PM 31231850 <br />Work will commence on or about ~6~/~1~0~/2~O~1~6 for approximately 60 days. <br />I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />lilt>. <br />nature of Applicant.Title <br />E:\PLJB-SV.WK\'MSTER,PSIENCROACHMENf PERI.'JT APPLICATION.DOC (0111l8)