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i .�it.i —•i vi . .all vel-IILI\ JLI'•.V 1'.+L. I f'tl1 IYV. GG1J`iV`-t✓Jl JJ I C1J. V1 GJC.1Y 1GGll II I G <br /> APpr1CATxON FOR zN'=0ACMM= PERMIT <br /> Date OFFICE ME ONLY <br /> To a Sam Joaquin County 6TOS # 7.3 b77 Pm <br /> neepnartme=tt ot Public Works APSE Ck� <br /> W. DATS U 1 v[1111 i�'`�A�l CA <br /> l�7 SM\j aVALTJ> S' o70z 8 DRIVEWAYS: <br /> (.Applicant Na=e) STRRST 7`5 I� � <br /> TYPE s����.w ;or ,e- <br /> (W1ing Addrans) FORMS <br /> NOTE <br /> (City, s�te ,xii Code) " <br /> (Area Coda Telephone Nbober), _ <br /> Sketch (Detailed plass may be submitted) <br /> The undersigned hereby applies for permission to,excavate, construct and/or <br /> Ch om Couabyu Dighway fight-of-Wayoa the L�14FCfi'.L� aid}�,uf <br /> ST, <br /> approximately g -AST <br /> of g►\'� Cr .. . h <br /> y: ex O=ing the <br /> fol lowizag work (,description of work) <br /> '�'��A�ti \�CTS'• ?��.X � � ___.�'+,�,L. W or_.�_ ^-- <br /> WoBkc�.'�l <br /> will comtence on or-about: 1�.•O1~O"1 dor approximatelyLo Q <br /> days. , <br /> Z, the undersigned certify that Z am the owner of the respective property, or am <br /> qualified to represent the owner and .agree to do the ,,fork descri�bad above in <br /> accordance with the rulep, regulati, xis'oi San Ybaqu�in County and subject to <br /> �,- <br /> inspection and approra.(001 �C�$�, . <br /> z ix <br /> sis=tt=a of Appli.catut - TItle <br /> . Dater <br />