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10/'24/95 15:09 X 209 895 9195 FENNFTT'.BENNFTT F.02 <br /> APP LICA'1'i��iy Ft7Ii�l CRO�,.0 ,NT PERMIT <br /> PLEASE PRINT: <br /> QUICE U811 ONLY <br /> Date JOB fl„ ZZOa REPH <br /> APN - CRVff <br /> To: San Joaquin County Highway Department. gyp.DATE - <br /> I VALID/oe O DRnrLNVAYS: <br /> STILET Or <br /> � PPlicant dam AREA 47e4r,* QUAD S W • <br /> TYPE,eBo,Oe� _ _ t - - ---- -- -- <br /> .�. FOR IS s s/w(ia, <br /> (11T.�►ildxitg t�.ddreSs) <br /> NOTE <br /> (City, State Zip Code) ------------___. <br /> cn <br /> r CA „ <br /> ca CQ c-Telephone Numbcr) <br /> CD —, <br /> Sketch(Detailed p1:r..5 may be submit4:,d) i t <br /> co m <br /> o <br /> Ao'!x-40�.fore <br /> Undine m •-�1��'�- <br /> The undersigned hereby applies for pemaission to excavate, construct and t or oche "se encroach on County <br /> IT-ghway IZait-of-way ift the o:�., approadmutely <br /> �L00 ejl�v mile of J r' byperfonmiug 11 <br /> following work: (description of wozic): <br /> Work will comrncuce on or about _ — _ for wrmematcly L C2 days, <br /> Z the undersigned certify+_hnt r am tho e,Amci-of the resp cc-Uvo property,or am quaUled to represent the owner W <br /> agree to do tbo work descn-bed above in f,wor&-uice with fhe rulcy,regulations of San Joaquin County and subje <br /> to ins o d approve <br /> SIGNATURE OF APPLICANT - ME AT6 <br />