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APR-04-2088 16:01 From: To:120946e9324,1240# Pa9e:2-3 <br /> CJ-41 Ct4!LGYJty I n:4 1 1b1J4bd9324 SJCO PERMITS PAGE 02/02 <br /> Ap �IC�, zD FOR MCROACOMM PERMIT <br /> �L�:ASE„PR.Z tN'T <br /> Date 7 ' a$ 0rFSC$ Ct6a ONLY <br /> TQ: San Joaquin County dQ�s %/ �P-- REF # <br /> Department of public Works APR <br /> __ 'SXP. D,ATIF <br /> /I L f RT I � � L� t �, VALID j6&536 TO -4�- DRIV&`MTS <br /> {A 13aasit Name) STREETO <br /> � ✓ Clls�,c :r - <br /> (mailing Addreea) FORMS <br /> YOTE <br /> CA C1 3-7 <br /> (City, stats, Zip 'Code) <br /> 5-9) 46G q 5- <br /> (Area code - TalophOWD s) <br /> Sketdh (Detailed plana may be a itted) <br /> i <br /> 5 E E ATT/4 C,A <br /> The undersigned hereby applie fa permidoion to excavate, ponstruat and/or <br /> otherwise encroach on county gjghay Right-of-dray on the T sido of <br /> S approximately �~ eet iie- 5OUyq <br /> of Verformiag the <br /> following work (description a Wok) <br /> $ V La 5X AT Z wT <br /> 4.0 C T IV <br /> L O/4 NS tJ4 Lr 5 <br /> C Ro 1 N O CV V t r co -r Ot�l, <br /> Work will commence on dr abou Ah for approximately <br /> `o� days, <br /> I, the undersigned oertify th t x am the oWl%er OP the respective property, or am <br /> qualified to reprepent the ow,,jrr wd agreo to do the work deocribod above in <br /> aO=fdance w4th the ruses, re 1n iv�ns of San. Joaquin Ceutty and subject to <br /> inspp,otion and approval. <br /> e <br /> ij,gx�ature of App7.iaant - TitlR Date <br /> xna�x.rs�pnnaamt, rr/am <br />