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APPL.t(.:fl'I'3UIV I'UK t:IV�:1�(1A�HIY111ir.t. Y�Ki�'lt 1 <br /> PLEASE PRE't'T: <br /> : s OFFICE USE ONLY <br /> Date JOB # REF# <br /> APN - - CRV# <br /> To: San Joaquin County 16ghway Department. EXP, DATE <br /> - VALID .5; TO 1!5--v-7 DRIVEWAYS: <br /> AI)4/-\NCFD CTEOENVIRONMEN-CAL C. STREET T-c-RQ. r-tyo A C. ; <br /> (Applicant Name) AREA QUAD <br /> :., TYPE_ _ # <br /> ._ <br /> "6 )-1 SHAW ZOAt') FORMS <br /> (MadingAddress) NOTE <br /> + z 7i0CkT-UN Cly. <br /> (City, State Zip Core) <br /> k <br /> 2-0 q) `7 - tCC, <br /> (Area Code -Telephone Number) <br /> Sketch (Detailed plans may 1N submitted) <br /> i'L A\S SEE A,TT^Cs6- t=tJ ?Lr`r�1 t-)PTE .iANvAP, zGG�. <br /> i� <br /> The undersigned hereby applies for permission to excavate, constrict and/or otherwise encroach on County <br /> Highway Right-of-Way on the 4,, c 5 T side of RP,�►!c t_Y�y a v t�r.�;� _approximately <br /> -70- c'►Ceet 1 rule of M ,/_11 AT 4i,'_1 r� wo do Ay ., ST<c,-1�Tc��1 , by Performing the <br /> follo'Wing work: (description of work): T ATT ;�� „r 2-r � H t�v L , C�� T �EL _ <br /> iV 1= it i,t T w F t=om <br /> C AN EET � �11Vd mW �` _r Q EFNEh krT-eaFEI"V -7Q HNn `� PET <br /> Work will commence on or about (DL N per- L- Zo- for approximately 3(p 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 described above in accordance with the rules, regulations of San Joaquin County and subject <br /> s to Mspection and approval. <br /> rpt. <br /> 9Y SIGMA OF APPLIC r�NT - TITLE DATE <br />