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A PPUC AT IIM Pnp gmrP_rvl,@e P F[! p.r€-ppnP,riey <br /> ctvcL_iV i u&E oun F <br /> PLEASE PRINT: <br /> Date —�p—/ ------ OFF(CE USE ONLY <br /> 10: San Joaquin County JOB per— <br /> 11 Depatm-4^; � REF <br /> APv <br /> o CR <br /> INVFN f t l2S �4 �►lRst7Z of�owiwtc'!'tc� 'VALID ATE lZ s �S� <br /> (Applir� e4tFR! f rnrr ►ZS �� 10 �'�- 5 %T'� DRIVEWAYS: <br /> Vo V 1( 0 s ruzc i <br /> ARCA LAN__--a�—QUAD <br /> o� 3 TYPE <br /> (11 a€[tn Address) FORMS <br /> ---- L/ NOlt�n! f �F/1 c -ZIT PSQTES <br /> (Ckf,State,Zip Code) ��oP.`I Vie' ►a+�- - - - <br /> (Ae ea Code o Teiephzmurnber) M'3tfL. S:co'Pn� 8: eK <br /> Sketch(Detailed pians may he submitted] <br /> r <br /> te0 T S T <br /> J <br /> The undersigned hereby applies for permission <br /> the__ 0-(1 sof GOM5 to excavate,construct andlor otherwise encroach on County Highway Right of-vvay on <br /> o� rLowT STI <br /> of -- approximately feeftle <br /> "y petorming ihe.foiiowing work(description of kvork): <br /> .00 �.nn --$ :30 low. L.t o q <br /> .Ir�'SR•4'1 o w. <br /> Work will commence on or about. cc�v►� Zoo 5"--- <br /> _for approximately_ F-4ov� days <br /> 1,the undersigned, certify that 1 am the owner of the respective property,or am qualified to represent the owner and agree to do the- <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Lt' .,,,.- (Scuta.,-� ✓vt Eyy��St� -- l �-- �c — /J <br /> of Applicaili Trtie <br /> F.LICE IuERi4CcSCt&:IC�1PU3-SV-,'JKL:.ASTE?.p5LR2CR0ACH:IJ{T FEfJ.!IT f.°FLICATIO!I DOG(a?It?J <br /> 1 <br />