Laserfiche WebLink
,. <br />PlEASE !"RII\IT: <br />Date 3 -.2 -2016 <br />To;San Joaquin County <br />.Dep.rtment of Public WOIKS <br />f b-H:fiJ'fl ~1 I 6"/!if3- <br />(IlfJe'i.:<~W.{;(;,i <br />~16,"'!t)<!L.o?.\f,;;~L,1"i\'L <br />-(Rn[l~fij'~£i~f.~~j::,1;I3SS) <br />$t.~oJ'C TDI1l I e..+\q:f"";l!O:{- <br />(eily,St~,e.Zip Co&) <br />(2.i!:4)<;7=I-q 't 32- <br />(Are1iCooe.Telllllhone fJlMlIlei) <br />Sketch (Detailed plans may be submitted) <br />~ee.a:t-h1/c.heel <br />JOB# <br />APN <br />EXP.DATE <br />VAUD <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />.';3005~-("REF ;\1 <br />CR# <br />'TfrS"IIf., <br />>1 BII'"TO '1Z,:spe.DRIVEWAYS: <br />'6'ft2L>tJ RD.i SAtJ:J1>~~D,• <br />7tU1t:-'f QUAD So,), <br />13(••&I",<_m4£&)t tie",,4d..,,~Q)9(ww <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the B ••th side of 8::1rM Rd~approximately 't 6 0 ~mile SE <br />of \.Ii C.r-M\t L ,'••.-e g"Trl!.e-l~.by performing the following work (description of work): <br />Work will Gommence on or about for approximately /20 days. <br />I,the undersigned,certify that I 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 />j(.o~ <br />Signature of Applicant -Title <br />3-..2-.:ao 16 <br />Date