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tz:^ APPLICATION ION FOR EiN C.IZOACHINTEIN T t EFUIVHT <br /> » <br /> PLEASE. PRINT: <br /> r OFFICE USE ONLY <br /> Date JOB# REF# <br /> _ APN CRV# <br /> Y To: San Joaquin County Highway Department. EXP. DATE i s-en <br /> VALID S-- -ej 7 TO �-r5-o7 DRIVEWAYS: <br /> L' n,rF-p GE()FNV ZIPONMEN-TAI SNC. STREET PePUK-LY" AJC. <br /> (Applicant Name) AREA a l Tv QUAD <br /> TYPE_ ` <br /> '33"1 SHAW ZCoAD <br /> FORMS LuvJ 12-17 <br /> (11TailingAddress) NOTE <br /> `iic)CktON CA �`7Zt5 <br /> c -- <br /> (City, State Zip Code) <br /> (a.uq) �16 � - IGGb <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PLtASr= SEE. ATTACt-1EO WOXY- e^-LlAr1 DATEp \S jAhVA};Y 2007, <br /> � 1 <br /> r. <br /> The undersigned hereby-applies for permission to excavate,construct and/or otherwise encroach on County <br /> Fighway R ght of`Vay on the side of a Ar i �Y,� Av w,'J�F approximately <br /> mile N-N+,.! of Mr/- 4 a,T 2 4 7 f F-, rn,.,r, t�AVE,, _STc >t c �1 , by performing the <br /> following work: (description of work):_-r N srr.\+ L A v T oiI0 F 2 T N fl-' Pv r , ; 1 1 t2F�a-- <br /> CGLO �T wC JJ E. L- , M+ r - 71 S FF 114 F-D .R eTW r- PM _- <br /> - rEE.T.'� AN rl� h r Cr _ - 57 ,E L-1 21.-r..,r r,._, Nn b-' GG FT <br /> Work will commence on or about <D 7 for approximately ;Q days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work descnlxd above in accordance with the rules, regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> SIGMA OF APPLICANT TITLE DATE <br /> �f <br /> 4 ^ <br /> T 4-. <br />