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v .J?� �.1 G•^_U.i=? i�'+.,.-.L_ � :J C1b �✓C/C/�LJ '��:K __- �rr <br /> De?a�tiTi T2t O` <br /> S: <br /> {APpl_CemLt Fran) Ste�-L &21AIAZ <br /> (Yai'i;4mg l d-resa) FORMS l <br /> NOT3 <br /> (City-, Stata, .Zib Come) <br /> (Asea Code - Telephone Number)• <br /> Sketch (Detailed blanc tray be submitted) <br /> Khe undersigned he-reby applies for p ss.ioa to•excavate, Coastruct and/or <br /> othe--wise-encroach'am -County-Highway Right-of--Ky---oa-the <br /> approximately =eet jTti?e <br /> of "perfoxLaiTiQ the <br /> --ollowing work (description of:work) <br /> K+ tl <br /> Work voa l" commence on or'about approximately <br /> days. <br /> I, the uadersigued certify that I ant the owner' of,the respective "property, or am <br /> qualified to represent the owner and agree to do the x7*ork described above in <br /> accordance with the rules, regulations'of San Joaquin County and subject to <br /> inspection and approval <br /> Signature of Applin—t - m,tle W'C Date <br />