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• <br /> V� <br /> APPLICATION FOR Ell CRQACIIAMENT PEI011T � <br /> PLEASE PREM': <br /> OFFICE USE ONLY <br /> Date /O L�—¢S JOB it 73 e 0-b REFff <br /> APN - - CRV# <br /> To: San Joaquin County Highway Department. <br /> EXP. ss� <br /> Vr1LM/o 'TO DRI«NVAYS: <br /> STREET;; .. <br /> G 6 <br /> (Applicant Name) AREA QUAD <br /> TYPE Z'i 6r vc,17Z <br /> G 0 5— FORMS _ ss <br /> (I LaWng Address) NOTE <br /> *P�:;", 64,iZ <br /> (City, State Zip Code) <br /> X09 �,7-7-V95 7S <br /> (Arca Code -Telephone Number) <br /> Sketch(Deviled pl rs :lay by submitted) <br /> 4Z7 co <br /> r'l; CA <br /> -o <br /> -f p t„ <br /> cz <br /> _Nr'. 7 <br /> M <br /> •• Drn <br /> v O - r <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> Highway Right-of-Way on the side of wQe� approximately <br /> feet I mile of ,��r�% ��y, , by performing t <br /> foliowork: (description of work j: <br /> i`g cn4r a rg /GX y4a tel. l'lsr z�J <br /> Work mU commence on or about 10—Ig — for approximately_2 days. <br /> I the undersigned certify ih:,t I am the owner of the.res-dive property, or am qualified to represent the owner a <br /> agree to do ilio work described above in accurdancc with the rules, regulations of San Joaquin County and subj <br /> to inspe , d approval. <br /> O ` <br /> SIGi1ATLRE OF APPLI .'-u T - TITLE ---�f DATE <br />