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Date d - CJr' " <br /> i?S- l4 CI <br /> —� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7?U 7y <br /> # <br /> Department of Public Works APN REFCR# <br /> / EXP.DATE <br /> VALID TO DRIVEWAYS.- <br /> (Applicant Mame) STREET ��, ly„ <br /> . <br /> i/ <br /> AREA f�� I, v, QUAD AIF <br /> zif��' TYPE f� - <br /> (Malling Address) FORMS <br /> T NOTES <br /> -157707 - - -- --- - --- - --- - --- - -7 7 77_ -_ <br /> (tarty,State,Zip Code) - - -7777 — <br /> (Area Code e Telephone ember) <br /> Sketch(Detalled plans may be submitted) <br /> O _ <br /> r <br /> i A <br /> ZS)(Z'dkeap <br /> " v <br /> Q—f'acI <br /> m <br /> F«u,1e6r5igi eo;ereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the-! side of ti, �-iJ es N k�r►i1 �', f� ,( approximately 2 5' <br /> of - feet/mile <br /> by performing the foAowing work(description of work): <br /> n. <br /> /14 ift1�' �1 d "2 erg �e �? ;7 "`t e t f �T y ilki� <br /> C' -C GF <br /> Work will commence on or about r -/.�'- 2 "141 for approximately <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to rin fl- <br /> work described above in accordance with the ruies and regulations of 6a joayunr uuurny anu surllecE <br /> A:ICENTRN.SE(YVICtS1CL.EFi1CILLIH185V-WKV.Ul5TE.2PSL`ntltUnGN`tttt yyn._y.:_, _-_... <br />