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_A�P��t CATION ;t R, l 1tROACII,NT PI1011T <br /> PLEASE MUN'l': <br /> +FICL USE ONLY <br /> Date,1z —7- S .TOE it /l d REF# <br /> APN - - CRV# <br /> To: San Joaquin County highway Department. E.P. DATE Z <br /> VALID/2/J; Sj—TO DRIVEWAYS: <br /> STREET X,n'cS®A�-, TLS <br /> (Applicant Name) AREA 7-,C-yC1 QUAD -5J� TYPE Ti��tic.51 # <br /> l c'Z S Yos�W1IT U Ll/d• FORNTS <br /> (Mailing Address) NOTE <br /> �IOD�s'TO , G� 9S3S�-Z99� <br /> (City, State Zip Code) <br /> tog- <br /> /'ZOI,) 52 <br /> (Arca Code-Telephone Number) <br /> Sketch(Detailed plans ..ay be.subrait:ed) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> Highway Right-of-Way on theEAsr side of �ASdo/c/ AyZ. approximately <br /> /600 ec t anile 510uTN of D�rES�'��4r� iPo. , , by perfonniug <br /> following work: (descripvon of work): oe6&PG SILL EX/STING 5RALLO(d P/PE w� <br /> it16x,, ZV " PVC PIPIF Lx7-"-,4- —ro I"Ixi L/jcT' <br /> C��AI <br /> Work will commence on or about W&,�54 or /b' aF /,�eF�rBF�for approximately�_days. <br /> „ I the undersigned certify+hat I am the owner of the respective property, or am qualified to represent the owner <br /> agree to do tho work described above in accordaucc with the rules, regulations of Scut Joaquin County and sub. <br /> to inspection and approval. <br /> T OF ArPLIC,6u <br /> �T T - TITLE DATE <br /> C/,E,ci� �•�/�5�2 <br />