Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br />"PLEASE PRINT: <br />Date OS/20/2016 OFFICEUSEONLY <br />* <br />DRIVEWAYS: <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WESTLN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />-"--'-'----~-'---_._.._-----_._--.-_._- <br />SEE ATIACHED SK~~~~J""'e ..._-~-_....._..._._.._.._.__._._-_..__._- <br />i,,,,,:-c-.-_;,subJeci to pavementcub shollreceivean(1)inch asphalt concrete overlay from the centerline (or:-lonelme)to the edeg of the travel way as per the Son Joaquin <br />C.Qunty Trench Cut ~o)jc¥.If .the pavement is disturbed on both i," <br />sides of the centerlme {or adJocent lane),then the entire : <br />roadway (or affected lanes)shoJi be resurfaced.Contractor <br />sholl grind and overlay within 10 working doys of permanent <br />trench poving.Shoulder areas sholl be brought up to finishgrodeosdirectedbytheCounty. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the SOUTH side of S.TUXEDO AVE approximately 206'feet'mile EAST <br />of MISSION RD ,STOCKTON .by performing the following work (description of work): <br />EXCAVATE (1)5'x5'BELLHOLEAND (1)5'BORE TO REPLACE SERVICE TO 1848 S.TUXEDO AVE <br />PM:31231180 <br />~Ptr",,\- <br />S!Jt,.l1lIfureof Applicant -Title <br />Work will commence on or about 06/01/2016 for approximately 60 days. <br />/': <br />I,the undersigneil,ceftify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work describetlab e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.t:- <br />E:IPUB-SV.WKIIMSTI:RPS\ENCROACHMENT PERJ.lIT APl'UCATION.DOC (OlJlJ8)