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Sep 05 07 03: 48p Dan end Alicia Schmierer 209 951 5907 p. 2 <br /> 09/30/2007 08:24 20946. _324 SJCO PERMITS PAGE 02/03 <br /> APPLICATION FOR 2MCROAC3KENT PERMIT <br /> PLEASE RINT• <br /> Date? 6'2'C�L. OFFICE USE ONLY <br /> To; San Joaquin County JOB # X100 REF <br /> Department of Public Works APN 001-1 C-0'L Cg # <br /> 1� /� EXP. DAT r O <br /> A I t� � t rti f;)cl�r A't a e,? { VAL.In I To n1 DRIVEWAYS: <br /> (Applicant Name) STREET -k <br /> AREA Py%�O.AMPo QUAD �- <br /> 02� � N0. i �k n C i �I`L�. TYPE �OAD �MPR•oJE MEN <br /> T* <br /> (Mailing 1ddreaa) FORMS ��I7; SS.'M�LJ <br /> NOTE <br /> Cr�.YY.1�C, r C',� <br /> (Ci y, state, Zip code) <br /> (Ares Code Telephone Number) <br /> Sketch (Det-ai7.ed plana may be submitted) <br /> The undersigned hereby appliea for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-cf-Way on the side of <br /> [A(k.4-rs' approximately �� e /mile <br /> of by'performing the <br /> following work (description of work) : _ w�GQ6u�tnC, r:{- -fit... ex�sA,,H �111W.LVV,1!114 b <br /> work will commence on or about kD1,111 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 /> ine action and n oval. <br /> Signature o£ pplicant - Title Date <br /> �eTax.re��a�ec�r, ce!❑�1 ��''n�'C� <br />