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i <br /> APPLIC*tld�FdkEWCR0*ACHME)VT KNIT <br /> PL•EASE ARIK: <br /> — i <br /> Date >C :` e ; OFFICE USE ONLY <br /> i <br /> To: San Joaquin County JOB# 3005 �=` REF# <br /> i <br /> Department of Public Works APN _ CR# <br /> EXP.DATE _ / v <br /> VALID G 20 to TO f// .o DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA ZOO,, QUAD *1W <br /> � . �' <'" �: f . . TYPE I <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,zip Code) --- <br /> (Area Code-Telephone Number') - -- <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> J E <br /> 1 I <br /> { <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �/r�ftT,h _side of w . Y ate._. approximatelyof Y. A-10. by performing the following work(description of work): <br /> -WO *147,111.10el4k <br /> /,y` .+/o �"G. -^t�J.✓sVc'"'-, �.,$"1.r` 'ay>L�.er'i 's,''+&', y .t'f.�y' s <br /> 414 <br /> Work wilt cornmence on or about,!�jPfor approximately —days. <br /> I,they undersigned,certify that I_am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordartCe.with the ries and regulations of San Joaquin County and subject to inspection.and approval. <br /> l Signature of Applicant-Title Date <br /> v+Poac;a*F awaa+C nmairNr renin AmrcArmex tomm <br />