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b"'lEil.SIE b"'~!ilif; <br />Date Z,-.2.1.f ~~t>16' <br />To:San Joaquin County <br />.Department of Public Works <br />5+n)c.+"'''D 6A q £7ao t{-ltily,siaw,lulOl Cf]!II~1 <br />L20V .573-.qq~2-.lAma emile.TeielOll1f]ile~~um~a!fl <br />Sketch (Detailed plans may be submitted)5ee->te:eA-~ <br />~I <br />OFFICE USE ONLY <br />JOB#7800224>REF # <br />API\!CR# <br />EXP.DATE .'1~~ <br />DRIVEWAYS:VALID ;/j~'1 15"1t.<> <br />STREET Au4,n M.e <br />AREA 1tMg~:t ~-t:~E" <br />"-TYFE ?ole.,g'Yl1.2-Ylh 4 p.e;J <br />FORMS ~w . <br />NOTES <br />7 P"/e,>.s,~.f~U/$e..- <br />1:'-'!.J C-D Iff!)tV <br />71f?le$N,tJ.f CI'l-Rr 1..20 <br />f~5:Yeo «(J tV. <br />The undersigned hereby applies for Rermission,to excav te construct and/or otherwise encroach on County Highway Right-of-Way on <br />the W side of A£<.,-t,.II approximately feetlmile _ <br />of Beft !A,ee f\'-II>U .'S'e ""'-fAd,c::-1+R:r I.l.O,by performing the following work (description of work): <br />2.'>L(Jeet-tI'{"I~al,.,I.'1 AfA.sft'".ef:f -t<epL;;:e.e.Pole.. <br />Work will commence on or about :5-I -.2.()I 6 for approximately /:2.D days. <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified to repr€s€nt 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 />i<()4v"e~ <br />Signature of Applicant -Title <br />~t1GEImlAl..SERII1CE5'.()lERlC!ll.\PUB_SV.WKIMAS1ElU'SlEtJc:ROACIJMENTPERMlf f\PPlJt;ATIOltIJOG (OOIJ3) <br />2.~2.4,1-/6 <br />Date