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<• <br />:".:,'..•~, <br />APPLICATION FOR ENCROACHMENT PERMIT2018 JUN Il,fJ)10:52 <br />PLEASE PRINT: <br />Date &/tV /1 to;~. <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department ot Public Works <br />(Applicant Name) <br />lJ{"t UU <br />(Mailing Address) <br />.(-44 CJr4l{ <br />(City,staie,Zip Code) <br />JOB#~).•b <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 />?)MdM~/c1 <br />4t:!y -3/(",-17 t"7 <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted). <br />sffe /IH71A-f..lf8f'>St-f-.-TlJd <br />;'111 4 'lsi <br />tv"',Y"""'"..subje.d to pavement cuts shall rscelv:an(1)-inch asphalt concrete overj-ay from the centerhne (or ~anelirie)to the edeg of the travel way as per t!Je ~on JoaquinCountyTrenchC!-!t Policy.If the pavement IS dlsturbe,~on bothsidesofthecerderHne(or adjacent lone),then the entrre troadway(or affected lanes)shall be resurfaced._Contrac orshollgrinddndoverlaywithin10workingdaysofp-er~a~ent .trench paving.Shoutder areas shall be brought up to ffl'llSh <br />grdde os directed by the county, <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Ri9ht'of'wayw <br />the AA}I-side of Q"')IA-?......approximately &¥'1.l@tmile ~ <br />of .<,"I""S fQL-lc.l1W ,by performing the following work (description of work): <br />[L <br />Work will commence on or about tRbo /JIi,,I for approximately 110 days. <br />&,/Nj/L..DateSignat <br />I,the undersigned,certity that I am the owner of the respective property,or am quaiified 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 />E;\I'US.SV.W1<IMASTERPS.\ENCROAGHMENT PERMiT APPLICATION.DOC (OlIDB)