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,.,. <br />APPLICATION FOR ENCROACHMENT PERMit <br />i'...'..'-S !\;',1 j C .;\(j ',j ~;.\.~C :....;({T \{ <br />2"'~ili;)'14ulu,jU!; <br />PLEASE PRINT: <br />Date &In 1/10,I OFFICE USE ONLY <br />(Applicant Name) <br />DRIVEWAYS: <br />REF# <br />CR# <br />JOB #13"""5'J..-CP <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />.fA!)Cfr4Lf <br />(City,Sta~e,Zip Code) <br />uk:ll UU <br />(Mailing Address) <br />To:San Joaquin County <br />Department of Public Works <br />'-tpv -31L:>-/7 c,..7(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Sff~J.4-=fTI/k.lfG(,)S'r.r--TlJd <br />tiL-'S,,!.,(,71 <br />MIIJ'""..._subjed to pavem~nt cuts shall reeem:emh1)~inch asphalt concrete overlay from the centerhne (or ,LaneIna)to the edeg of the travel way as per i.h.e ~an JoaquinCountyTrenchcptpoliCr.'If the pavement tS dlsturbe~on bothsidesofthecenterlineoradjacentlane),then the entire troadway(or dffeeted lanes).shaH be r~s-urfqced.Confroc.or . <br />sholl grind and overlay withm 10 workmg days of per~a!'J~nttrenchpaving.,Shoulder areas shall be brought up to hrlls <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 No.d-\"side of W1wJ ",'•.•approximateiy Q..~mile t5:,f- <br />of "(12-1 ,?7oo:.pw ,by performing the following work (description of work): <br />I....L IL <br />Work will commence on or about for approximately \10 days. <br />I,the undersigned,certity that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described abo .accordance with the rujes and regulations of San Joaquin County and subject to inspection and approval. <br />f,INj/&.Date <br />E:\PU8-SVWKlMASTERPSIENCROACIlMEm PERMrfAPPLICATION.DOC (01108)