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APPLICATIUM FOR ENC€`a®AGNMEN 2 MONT <br />T0: San Joaquin Gounfy <br />Department of Public Woft <br />(Applicant ffarte) <br />' (MailLngAddres�) <br />Ni (m 15 <br />(City, state, Zip Code) <br />t" -Y —�m: 1 1 <br />(Area Code 4Telephone Number) <br />Skefch (Detailed plans may bes`ubi <br />s�2 Q��oc`�.c�• <br />JOB <br />APN <br />EXP.➢ATE <br />VALID <br />S`IREEj <br />OFFICE USE ONLY <br />730077 REF <br />CRtf <br />B/15/2020 <br />'6/812020 TG' .8/15/2020 DRIVEWAY& <br />Hinkley Ave. <br />AREA <br />TYPE <br />Stockton QUAD ES <br />Bell Hole <br />FORMS <br />NOTES <br />SSNVW, R=29, Trench Cut policy ' <br />Special Conditions <br />"EMERGENCY <br />WORK' <br />Thean ersignedhereby applle5f_ for et is1stPonto xcavaf cgnstructatd(grafhel'wiseencroaclionCountylllgh Right-oMayon <br />the side or1n�c tk U2 appr4ximate(y; `� fee 116 5b <br />hypeda[ming the following work Udption of warlt): <br />Wodeudlicgmmenc onoraboufi -`1D forapproximately days . <br />€, the undersigned, ceriifythat i am the owner ofthe respective propet{y, or 6m qualified to represenffho owner and agree to dq the <br />Work dasc bedaboveinaco0rdancewiththerulesaudregufaiions'ofSanJoaquinCdunfyandsubjeottoinspectionandapproval. <br />��iuuli�ur►rr� /�'( khnnS C�ell�-f,-5-2-42.0. <br />D%naturn fA0l.i-live Date <br />L10EN�p,WgEiMCESfCIHtlChLWItiSV.WANAASiECPS1p7�R0ACHi k7RPEflFIRAPp{ICA7U1000 (0 iq <br />