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APPLICATION FOR ENCROACHMENt PERMIT <br />DRIVEWAYS: <br />REF# <br />CR# <br />OFFICE USE ONLY <br />JOB #1$t>05J,.-(0 <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />/C <br />(Applicant Name) <br />San Joaquin County <br />Department of Public Works?G- <br />PLEASE PRINT: <br />Date U/IDjI c.., <br />To: <br />&J~:rt (,IU <br />(Mailing Address) <br />_~kk.+ev.CPt 1S2a'-! <br />(City,State,Zip Code) <br />4&-31~-17C.7 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted)Ser::-t-4-7TJ4c..HEi'::,sten..11 <br />tl z»I z..<j <-11 <br />.. <br />L1u""\~fW""\ubjeet 'to pavement cuts shall receiv~all(1)-inch asphalt Done-rete overJay from the centerhne (or ,Lane <br />line)to the edeg of the travel way as per the San JoaquinCountyTrenchC!-J+Policy.I'f the pavement is dishlrbe~on bD'I'nsidesofthecenterline(or adjacent lane).then the entIreroadway(or affected lanes)shall he r;surfaced.ContraeJorshangrindandoverlaywithin10wotkmgdaysofpenr;a~ent .trench paving.ShouLder areas shaH be brought up to finishgradeasdirectedbytheCounty. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the $1'~side of e.41.-.,,"..,tL,~\<.l \0 approximately Z-.~mile ££t"~£ltv,,).,~..,,17'01,"",Ce..••.,If',by perrorming the foiiowing work (description of work): <br />I/)l\.t.~:."..<;\1''''1.r:-..£"Wl<V!{.-J£7 Lt's k.f..e.fe,;c . <br />days./2Dforapproximately <br />t"""..f CtrYj,.",~I...v <br />ant -Title <br />Work wlii commence on or about <br />I,the undersigned,certif that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described .accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E:\PlJENlV.WliIMASTER.PSlENCROACHMENT PERMIT APPLICATION.OOC (01/08)