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APPLICATION FOR ENCROACHMENT PERMIT 20'16JUil 1'-1 Ai~\Q:S4 <br />PLEASE PRINT: <br />Date U/;o II G,r' <br />~")\;..ILl'.... <br />OFFICE USE ONLY <br />DRIVEWAYS: <br />JOB #'lJa1'iJ'/P REF # <br />APN ~_CR# <br />EXP.DATE <br />VALID Iltz~ <br />STREET I I <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />,-C <br />(Applicant Name) <br />San Joaquin County <br />Department of Public Works <br />?e; <br />To: <br />&.h:J t.,IU <br />(Mailing Address) <br />"S -kJ;-bv..Ckt 1S2(Jr.j <br />(City.State.Zip Code) <br />l-fd:s -31 (..-1 7(,7 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted)'3C~14-7714c-HEj~Sf.:en.1I <br />~l(....,'7t~fr" <br />t-//..1/1-l-j )l 7 <br />GJ(.,1/4~( <br />~subject'to paveml';!nt cuts shall receiv:,an(1)-inch asphalt concrere overlay from the centerlln.e (or ~an-eline)to the ed-eg of-,the'travel way os per t.he ~an Joaquin <br />County Trench C[Jt ponc(."If the pavement IS dlsturbe~.on bothsides6fthecenterlineoradJacentJane).then the entrreroadway(or affected lanes)shoJI be f?surfaced.contradorshallgrindandoverloyw-ithin 10 wor-kmg doys of p-er~d~enttrenchpaving.Shoulder areas shall be brought up to finIshgrddeosdirectedbytheCounty_ <br />The u;J!lllrsigned hereby applies for perl ission to ~cavate,construct and/or otherwise encroach 9n County High~y Right-of-Wqy on <br />the I;;:;,;,;,-r side of ~.L I+ve approximalely 3>(p <feet/miie lU"vf-. <br />of <;;'OV1ll\M0 ,S,.Ju l?k...,,by performing the following work (description of work):=-tQ &W:'"'f"".",)60"",c-W1ftJ<o'l£7 Lt'sk.~•:c . <br />Work will commence on or about (.-./20 I/l.r J for approximately 120 days. <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 v'accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />ty••.•;f c,,,,,J,,,,,I-rv <br />ant-Title <br />E:IPUS-$V.WKlMASTER PSIENCROACHMENT PERMITAPPLICATION.DOG (01I1lB)