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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date J2/z6/ / 7 <br />To: San Joaquin County <br />Department of Public Works <br />�I <br />(Applicant Name) <br />LI o <br />6i __XXL Lyu <br />(Mailing Address) <br />A C l� 4 S zerN <br />(City, State, Zip Code) <br />y -3/4.-17C,7 <br />(Area Code - Telephone Number) <br />may <br />3 )3� ZIy2 <br />JOB# <br />APN <br />EXP. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />OFFICE USE ONLY <br />7.3&)5 2, REF <br />CR# <br />TO DRIVEWAYS: <br />Cf <br />QUAD <br />FORMS <br />NOTES <br />-} subject is pavement cuts shall receive on <br />(t)—inch asphalt concrete overlay from the centerline (or Lane <br />fine) to the edeg of the travel way as per the San Joaquin <br />County Trench Cut Policy. If the pavement is disturbed on both <br />sides of the centerline (or adjticent lane), then the entire <br />roadway (or affected Jones) shall be resurfaced. Contractor <br />shall grind and overlay within 10 working days of permanent <br />trench paving.. Shoulder areas shall be brought up to finish <br />grade as direcfed by the County. <br />The undergigned hereby applies for permission to excavate construct and/or otherwise encroach on County Highway Right-of-Wa on <br />the PV side of 251P� ,:(�t.9- . V 1 approximately 333- e*mile <br />of W. C,4bvitlie ,- , L aL z J , by per the following work (description of work): <br />Work will commence on or about /—J-1 8 for approximately ( U days. <br />work described above in ac�r�rd nce with the r sand regulations of San Joaquin County and subject to inspection and approval. <br />of Aooli-dant - Title <br />E:IPUB V.WMMABfERP61ENCROAL ME PERM APUCATIOR...OaC �Ifi al <br />7 <br />Date <br />