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_ _ U <br /> �J3 77 <br /> `0 5ZTCS <br /> r'�tr <br /> {yppZ?L`cS2� Tame) S T_E T <br /> A � <br /> CY-al ing kddress) FORMS <br /> 0Q <br /> (City, S tate' .zip Code) <br /> (Area Code - Telephone yunber) <br /> Sketch (Detailed plans may be submitted) <br /> a OL'# 0.0 e <br /> The tmdersirned hereby applies for Permission to.nr.�eavate, construct and/or <br /> othem-wase-encroach•on •County•Highway Right-of-may -oa the <br /> aDpro:L teZy _eetJ ile <br /> of h tier€orzd�iQ the <br /> follomr�ng -work (clescription of..work) aue'-� uax� '!JgL <br /> If—ii l3l C e'h C-wr-i' <br /> alk <br /> Work will commence on or'about IL <br /> 'Z for approximately <br /> - � © <br /> days. � • <br /> I, the undersigned certify, that I am the owner of, the respective •property, or an <br /> qualified to represent the owner and• agree to do the 'ork described above in <br /> accordance with the rules, regUlations'of san Joaquin County and subject to <br /> inspection and approval <br /> d�( �'Ac alylml( ZZ- <br /> [2 IL <br /> signature of ;Lppli cant T! 19 Date <br /> tLsrz 4lSVsssmL Woo) , <br />