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———— cam—.•–-- u.• � - <br /> A,PPbICATION FOR EXCnOA•Cffi4ENT PERMIT <br /> PIrEA. NT t , <br /> Data ' ��DID CIPFICS D'SU ONLY <br /> r. <br /> To: .San Joaquin, county JOB # Z&V REP # <br /> artmeat of Public Works APH <br /> CA's-1 VM" •\N AT7: t S'Ej&\Itv r i 3�0�� To s o� DRIvswUS 3 <br /> (ApplicantNaame) STREET <br /> AY <br /> T7CPSBg <br /> (bailing Addrazo) FORMS <br /> Nom <br /> (City, -state, -zip Code) <br /> (area Code - Telephone Number). <br /> sketch (Detailed plans may be eubmitted) <br /> 14 Scof C. <br /> May A"*' was <br /> • �•c3urfs�ecl r'n <br /> 44e Xwnwr <br /> vk zwo� fliue�+rc ltru� <br /> The undersigned hezeby applies for permission to.excavate, CcXLst ct and/or <br /> otherwise•encroach-on County Highway Iight-of-Wa ••oa•t o •' si e,.of - <br /> approximately ee fe <br /> of , • +• by per2ozmirtg the <br /> llo ng wor a description of work) : •"� <br /> Work will co=uAce on or'about foz approximately <br /> _��. days. • ' <br /> x, the undersigned certify that x ant the owner of the respective property, or am <br /> qualified to .s:epreaent the owner and agree to. do the- 4ork,.described above in, <br /> accordance witb• the xul s, regulat�. its'o9 San Joaqu�n County and subject .to <br /> inspection and appro 0�`OJ"o'1 <br /> Signature of Applicant - Title ... baits <br />