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PPLIC A'ATIO -70R <br /> PLEASE PRI'?vT <br /> Date - -lG— - <br /> _ OF2C$ II5s ONLY <br /> To : San Joaquin County JOB ff REF # <br /> Department of Public Works APN CR 4 <br /> EXP. DATE W_/7-0-17 <br /> VTUID 3-13-'a'7 TO 4'/S'-d'� DRIVEWAYS <br /> (Applicant Name) ! STREET ep, * i <br /> AREA y QUAD ,�Lt/ <br /> x <br /> _ <br /> Marling Aa <br /> Qress) 70 — <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> sketch (Detailed pians may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U-T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to .excavate, con s:�ruct, and/or <br /> nt,xerwise encroach caa--Coumty Highwav Right-of-Way on-the side of <br /> approximately :1C:'c feet/mile /a <br /> of by=peY€ormirig 1the <br /> following worn (description of work) <br /> Work will commence on or about �' �:. �� for approximately <br /> days. / <br /> I, the undersigned certify. that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title Date <br /> MASTL+P.DS%\PS.HS®L l0/00) - - <br /> i <br />