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F:i] <br /> LT5 __. :,_,�r <br /> Viz{F C ^ <br /> G: 5wZ .7GaLL'7� 2 LC;ti_'CZr <br /> 103 <br /> $APp icant ar,ey STPEE'T L.+%1 <br /> p?ZcA a QUADE7 TTPE <br /> 0Hzilia9 Lddress) FOPNS <br /> NOTE <br /> • (City. State, .�ip Cod®) ; <br /> (Area Code - Telephone dumber) <br /> Sketch (D(6_tailed plans may be silbmitted) <br /> T <br /> he LTIIdersigaed herebyarplies for permission to.excavate, a0lastruct and/or <br /> otherwise-encroach•on County-Highway Right-of-V1 y'••oa the l f"fh side:.ef <br /> 14"') approximatel <br /> o <br /> follwinJ Tork ( ,de ' • by `oer-a tL 'TiQ the <br /> • t'i. ,�(� �. scriptio�, of•,work} <br /> 10 <br /> Work will commence on or'about t � � <br /> days• !1`? 3 i for approximately <br /> I, the Undersigned certify, that I am the Owner' of• the respective property,' or a.m <br /> [�r - ;fied to represent the owner and agzee to do the Work described above in <br /> accordance with the rules, regulations •of San Joaqu-;n County and subject to <br /> inspection and appro�aI <br /> �ti's kL, <br /> signature of A li - ! <br /> PP czt Title D to <br />