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rT�'� ��.'. vd�� �Jt"� j;' j X1T{ 2214.9Y1? <br /> 1 <br /> San '70auir ccu ty/ .TOB 14__//D(n' �2�c <br /> Ce�artmer_t o aab'.ic ctorka SkPN CR �E <br /> t4-r�; r_�r= ,��=R�i--t -r EXP. ;1\TS <br /> o DRIVIEW YS <br /> (Applicant shame) STREET UT G9M,4 _k,L'__ - <br /> AR.EA,?'Ko,enlr Q <br /> TYPE �_�il/?gG e4&rrXDt — <br /> (Mailing address) FORMS <br /> MOTE _ <br /> - (City, Stats, Zip Cods) <br /> x <br /> (7i6 5 7 5 --- 15I -7 y <br /> (.Area Code - T'glephone W=b®r) -__--- <br /> Sketch (Detailed plana may oe submitted) <br /> The undersigned hereby applies ,Cor permission to excavate, construct and/or <br /> otherwise ezi.croach orL County Highway P.ight-of-wax on the _N�rZ-_rVJ _- aide of <br /> 0. V„40,,i_NU-r &ROVE Re-,&1; approximately <br /> of I-5 -_ - _-_ - by paxforming the <br /> following work (deacript.ion of work) . <br /> AS <br /> ( Work willCOMM nce on or about '`� '- s 07 for approximately <br /> c <br /> �A4d,rFt hk ITE days . <br /> I, the un,dez;aigned certify that T am t e owner of the respective property, or am <br /> T:,alified to represent the owner and agree to do the work described above Jr. <br /> accordance with the rules, ;regulations of Zan Joaquin Cou.�,ty and subject tc <br /> .'_.nspsctlonand approval . <br /> �... .� <br /> Signature of Applicant - Title Date <br /> +.1^,71.R.?4\?^c&B.EP]L '5/10S <br />