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►4V�?4 ! -?4E.P. No. <br /> ,o•�;.�o AUNTY OF SAN JOAQUO <br /> " ` DEPARTMENT OF PUBLIC WORKS <br /> Date Issued) <br /> '• '• Po eox 18 10 10 10 a w&zaroN wet <br /> STOCKrON.CAUFORMA 9520+ <br /> *� RMI"S-3000 <br /> HENRY M. HIRA7A <br /> ENCROACHMENT PERMIT (Expiration Date) <br /> 0.wcc*o• <br /> (Job No. ) <br /> To: - Encroachment type: ;•• ,• c <br /> Location: : t <br /> In compliance with your request of , 191. permission is hereby <br /> granted to do work in County right of way as shown on attached application and subject to <br /> all the terms, conditions and restrictions written below or printed as general or special <br /> provisions on any part of this form. See reverse side and attached sheet, if any. <br /> Trench excavations for service connections will not be permitted within ten feet (10') <br /> of pavement centerline unless ctherwise approved by the Director. Surface of trench patches <br /> shall match in kind and be smocth and even with that of abutting surface. Special attention <br /> shall be given to depth of utilities through roadside area in anticipation of future drain- <br /> age facilities, road profile ar.d/or frontage development. All underground utility facili- <br /> ties are to be established and accurately dimensioned on sketches from surveyed centerline <br /> of road right of way, not from right of way (border) lines. <br /> The Department of Public Works, Field Inspection Section shall receive a notice at <br /> least forty-eight (48) hours prior to beginning any work within the County right of way. <br /> All work performed under this permit shall conform to the rules and regulations pertain- <br /> ing to safety established by the California Division of Industrial Safety and Cal-OSHA. <br /> The jobsite shall be kept in a safe condition at all times by the daily removal of <br /> any excess dirt or debris which might be a hazard to either pedestrian or automobile <br /> traffic. All necessary traffic: convenience and warning devices and personnel shall be <br /> provided, placed and maintained by and at the sole expense of the Permittee in accordance <br /> with the latest edition of the CALTRANS Manual of Traffic Control. <br /> After completion of the work permitted herein, all debris, lumber, barricades, or any <br /> excess material shall be removed and the jobsite left in a neat workmanlike manner. <br /> Immediately following completion of construction permitted herein, Permittee shall fill <br /> out and mail notice of completion provided by Grantor. <br /> •� rte. l� <br /> Est. Permit Fee: $ <br /> ♦ ' �. <br /> FORMS: HENRY M. HIRATA., Director <br /> Department of Public Works <br /> WHITE - Permittee By <br /> GOLDENROD - PWD Central File Permit Section <br /> YELLOW - Field Inspection <br /> PINK - Permit Section <br /> PW 27 <br />