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APPLICATION FOR ENCROACHMENT PERMIT 20ifi JUN 14 ~h 10:53 <br />PLEASE PRINT: <br />Date (,11'11/to,7 <br />DC?r.~~;f::UdUC WORf\S <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />(Applicant Name) <br />LU{,:>t UU <br />(Mailing Address) <br />.{JIJ QS4t..f <br />(City,Stale,Zip Code) <br />JOB #7)(}()f;}..i-REF # <br />APN ~~_CR# <br />EXP.DATE Uat.t <br />VAll D (pjgJt",Oro If7:/& <br />STREET ~t1cihrJ /hie ..i ) <br />AREA ~JJ QUAD ~Z!t="~~~__ <br />TYPE <br />FORMS <br />NOTES <br />DRIVEWAYS: <br />4c,y -3/19-17 (,7 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Sff~/IB71A-t.lflH>stf-;tl.f1 <br />ULV1..lJ.SP1 <br />~"',~VlC.t'~ubjed to pavemem cuts shall rece'ive an <br />(1)-inch asphalt con-crete overlay from the centerline (or .Laneline)to the edeg of the travel way as per the San JoaqUInCountyTrenchCutpotiey.If the pavement is disturbe~on bath <br />sides of the csrlferlin-e (or ad~-cent lane),then the entrre troadway(or affected lanes)s a:1lbe resurfaced.Contidc.orshallgrindandoverlaywitl:lin 10 working doys of ~er7-a!,~nttrenchpaving.Shoulder areds shall be brought up 0 ~fllS <br />grade as directed by the County.. <br />The undersigned hereby applies fQ permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the A1~side of";,,u hM approximately 2 .5"\dWlmile 4Jd- <br />of t S DU ...-.-o;J ,by performing the following work (description of work):L IL <br />Work will commence on or about for approximately 110 days. <br />(,/I'I//L- <br />I Date <br />I,the undersigned,certify 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 rules and regulations of San Joaquin County.and subject to inspection and approval. <br />E:IPU~V.WK\MASTf'R.PSIENCROAGHMEWT PERMIT APPLICATION_DOG (01Il1B)