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APPLICATION rUK t[MUWAUHMM <br />PLEASE MEN' 1: <br />Date 9/16/19 <br />To: San Joaquin County <br />Department of Public Works <br />• . �; .} U <br />(ApplicantPI 0 11 1 LO <br />, <br />Ide Alf <br />Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />Luke Ruby 559-291-1024 <br />(Area Code - Telephone Number) <br />Address) <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED <br />PER <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Additional Contact: Luis ®rdaz 209-400-7074 luisordaz.rityrise@gmail.com <br />The undersigned hereby applies forApermission to excavate, construct and/or otherwise encroach ori County Hi Right -of -Way ori <br />the North/South side of E f�rospect PI approximately 165' feet/ ile West <br />of N Oak Knoll Ave _ by performing the following work escription of work): <br />LASAR to tie in at existing vault and bore 52' across E Prospect PI to existing vault in front of target address. <br />Work will commence on or after 10/14/19 for approximately 5 days. <br />I, the undersigned, certify that I am the owner of the respective propert <br />y, or am qualified to represent the owner and agree to do the <br />work described above in accorda� ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />- Title <br />Y:IFORAIS & TF1dPlATE51ENCIZDAEfl�NT PEWAIT APPLIf,NTION.tloc (tlflbe) <br />