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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 1? /,OFFICE USE ONLY <br />To: San Joaquin County JOB# 7,3 2— REF# <br />Department of Public Works APN CR# <br />(7—E <br />(Applicant Name) <br />Lil�uo G✓e,�1 Latl <br />(Mailing Address) <br />5 U9 o5 uQ <br />(City, State, Zip Code) <br />C/ u- 3lc.—I ? (0 -2 <br />(Area Code - Telephone Number) <br />may <br />G11S Z 7Z5d' <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />/'l01.16c4mosubject to pavement cuts shall receive an <br />or <br />(n')It tithe asphaltconcrete! <br />of thoverlay <br />wayrom file as per the centerline <br />yen Joaquinane <br />u <br />County Trench Cut policy, If the pvement is disturbed on both <br />sides of the centerline `or gdjacent lane), then the entire <br />roadway (or affected lanes) shall be resurfaced. Contractor <br />shop grind and overlay within 10 Working days of permanent <br />trench paving.. Shaulder areas shall be brought up to finish <br />grade as directed by the County. <br />The undeysigned hereby appliesfor�ermission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the {i/ side of ✓Vltajor_;L.&S approximately 12 e�t/mile�G <br />,j, <br />of iM I' 5.S I' ,, � �icre�,� by performing the following work (description of work): <br />Work will commence on or about /— V-1 e for approximately — tY ' days. <br />U -3:J -J, -uv e, 4 C_Tr L-, c' C 1 f - P. �'. L .. ..L:3 .. -. t.. .- - ''• _ <br />work described able In accordance h the rules and regulations of San Joaquin County, and subject to inspection and approval. <br />otApplicant- bile <br />EWUOSVWMWaERPSIENCROACNMEW PERMRAPPLICATIONDOC pWq <br />Date <br />