Laserfiche WebLink
.' <br />"',-.',./i" <br />S :-~~;;j (J f~C U ';-{ <br />APPLICATION FOR ENCROACHMENT PERMit ",'I'J 11.1-,'\0:532uitiJL,\;I'",\.1 <br />PLEASE PRINT: <br />Date (.,II"/1 h <br />j 7 OFFICE USE ONLY <br />,To:San Joaquin County <br />Department of Public Works <br />(Applicant Name) <br />iJ(:>'f UU(Mailing Address) <br />'fA!)CJr41..( <br />(City,Stale,Zip Code) <br />4t,y -3/<',,-/7(,7 <br />(Area Code -Telephone Number) <br />JOB #7?>00:SJ.-~ <br />APN <br />EXP,DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />• <br />Sketch (Detailed plans may be submitted) <br />Sff~~1f8f)St-~m1 <br />t11}-IC>,1("'il::> <br />10r:-.'51 'subject to pavement cuts shall rec-el'1:an <br />(1)~il1ch asphaH concrete overlay from the canterlm-e (or .Loneline)to the edeg of the travel way.as per the San JoaqumCountyTrenchCutPolicy.If the pClvement is disturbe~on both <br />sides of the cerlterline (or adjacent lane),then the enhre troodway(or affected lanes)shari be resurfaced.Cuntroe-orshallgrindandoverlaywilhin10wotkingdoysofper7-°!lhnt .trench poving.Shoulder areas shall be brought IIp to fnlS <br />grade QS dired.ed by the county. <br />The uncjersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the AJo.r',Jv-.side of 10 ""~,-approximately ->77 ~mlle ;;;;.~ <br />of bi Ii.'-IToe-t.1""1,by performing the follOWingwork (description of work): <br />1<J;o"L lL <br />Work will commence on or about for approximately 110 days, <br />I,the undersigned,certify that [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 rules and regulations of San Joaquin County and subject to inspection and approval. <br />(,/flIj/t,,Date <br />E:\PlJS.SV.WKIMASTERPSIENCROACHMENT PERMITAPPLICATION.DOC (01/08)