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'U A�'YL �- 1 iUi^�- FOR EI�l c.ROACHiY1E 1 PEB 0111 I <br /> k PLEASE PRIN"�: <br /> OFFICE USE ONLY <br /> ` Date JOB Y I�L REF# <br /> APN - - CRV4 <br /> To: San Joaquin County Highway Department. gyp, DATE -+5-0-7 <br /> VALID TO G-i 5-.G'7 DRIVEWAYS: <br /> AnvrNNCEt-) (ffE0EN\/1Q0NMEN_TAL.ZIVC. STREET �1XFa D aJE <br /> (Applicant Name) AREA s-ror k-ro K QUAD C.0 <br /> TYPE <br /> FORMS 51wu). )2- L`) <br /> (Mading Address) NOTE <br /> T_. <br /> S'- <br /> *' (City, State Zip Code) <br /> C2.0 -7 - ►CC,C, <br /> (Area Code -Telephone Number) <br /> Sketch (Detailed plans may to submitted) <br /> y�� t,LEHSF `EE P.TrACA-iED WG'iZK. t'LPN DATEb VSANVAR', 200-1 . <br /> k`" <br /> J+ <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> N.ighway R i ght-of-Way on the iN opu t-+ side of o x F o tz.c-) Av F_N v►= approximately <br /> 3< \/mile��� of M W-11 0 2117 t Ea i�Wuc�E, �-rc c�-rcjsN� , by Performing the <br /> follolvving`work: (description of work): OT-7 2-MMC H i v C: L.,)S-7 F <br /> G =To�Z—r_ �,r t_t_:s M''J Z3 ( SC 1z 57 PN a= p RF 1:\.J N <br /> _LA C) ANS i3J-TwEF_ '� -7� ANCA 20 FT) <br /> Work will commence on or:about n ; AP97-t_ ?,7,,c-:I for approximately ;n 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 /> to inspection and approval. <br /> t� <br /> �Yt 11,1 T <br /> 2 / 2-3/c7 <br /> SIGNA OF APPLICANT - TITLE DATE <br />