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To:SanJoaquin County <br />.Department of Public WOIks <br />PLEASE IP'RII\lli: <br />Date ;;~7~2c>~6 <br />2ulO i'iAR -8 PM 4:l}9 <br />.,-,.~,,r '!fOf)J.,"S'J'~'::P""(j,'-""dOLl'..•.'n l\n~1-,I,~_.' <br />OFFICE USE ONLY <br />JOB II 75vo5J-G REF Ii[-\Pili CR Ii <br />EXP.DATE 7(1'5"/11",~ <br />DRiVE\fVAYS:VALID 3/15[1&__TO 7,~£__ <br />STREET ~t/"r -fi..___, <br />AREA P2~"0..-.C~jf.\D 2f,___'_-=1TYPE~;;&-floa-""P4FORMS <br />NOTES <br />ef?,.311833>-7 <br />{~r.~rf,i,;Q~{;~~~m3J! <br />5 tCd-he "&\p¥u 9e.1~C;r~;:le.)Llr <br />(Ci[Y,SIt1J~e,ZitDJ «':[D~e) <br />Sketch (Detailed plans may be submitted) <br />See.a:t"+"l e.hed <br />The undersigned here~y applies for permission to excavate,construct~nd!o.r o!h;r.w!seencroach ont:;ol!nty Hi9hll'<lY.~!Rht-oHI'<lY on <br />.the 5.side of EER i ve,approximately "3 -f~rI;'; <br />of ilJI1SOl r £4,,,by performing the following work (description of work): <br />~e.pI?!<'.e..G '1-'1s-+t'!I\;}-A f\{!;~lA~c>~r _ <br />Work will commence on or aboul 3 -Ii:'-2&16 for approximately ell /)7-1-~o16 days. <br />I,the undersigned,certify that Iam the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described above In accordance wlih the rules and regulations of San Joaquin County and subject to Inspection and approval. <br />j(o~ <br />Signature of Applicant.Title 3-7-~o,6 <br />Date <br />M.\CENTRAlSORIJlCESlCl.ERJCAUPlIBSV.WKI!MS'fEFlPSlEllr::ROACHI.!ENT Pffi\llT APPlJ[;ATlDN.OO[;(ffi./13)