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R E �.ROr�iACII:MEN I i I110,1IT <br /> 9-61'f" <br /> PLEASE PRINT: <br /> OFFICE USE ONLYDate JOB ii REFti <br /> APNoiS� - S G - CRv# /'2/� ,70Z <br /> To: San Joaquin County highway Department. E)2. DATE 7 T <br /> VALID —TO DRIVEWAYS: <br /> STREET <br /> (Applicant Name) <br /> AREA Wa UAD <br /> TYPE_ T�,.t�-,A_j <br /> d X 3 Z ? FORMS -��-- <br /> (Mailing Address) NOTE <br /> U C4 �' z <br /> (City, State Zip Code) t <br /> (Arca Code-Telephone Number) <br /> Sketch(Detaileu phoxs :nay br subrait<ecl) <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and I or otherwise encroach on County <br /> Highway Right-of-Way on the side of approximately <br /> feet i mile of , by perforrn4 <br /> following tiVork: (description of work j : <br /> Work will commence on or about / Z // S— for approximately IS'6 days. <br /> I the undersigned certify tit!,,-m the owner of the respective property, or ani qualified to represent the owner <br /> agree to do tho ,vork desuribed above is accunlwcc: with the rules, reguiatious of Srui Joaquin County and sub <br /> to inspection and approval. <br /> 41NA�TURKF APPLICANT�- =�E <br /> DATE <br />