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Dafe .I',-/7 ,.-;>-OcL$~._-_ <br />To;San JoaquinCounty <br />'lJeparlmeni:of Public Works <br />[)"'/r-,f;,?I ,-,'7/IN;/b,"'~,~?;;:''/r~;.'L;;:;>l .+..2..'__0__ <br />(t'lilliiCflfiii:h\IRlm(7) <br />,0 ,,1l1.tu @h""~'".J...CL(J~@~_ <br />@Ifl<!i~ill!JAIDldi"ess) <br />r.t;.t.'&e..k..~f:DiJ\Gift 4',>2.,",II <br />(City,sifll:<J,lip COds) <br />(ztp!0J.2~-tI,'-3.52.'rl<'d:?(i-f.!')}",e@I!,(Area Code.Terephone NllUll!Jer) <br />Simi Detailed plans may be submi e <br />OFFICE USE ONLY <br />JOB II ,_7~f)Jl52-_:__REF#"--.ApN CH# <br />r,)(p,DiITE'~~~~_7-7f~lt___~~---------- <br />VALID .J=."t.:.L[;L TO _7._-/5"-.'G_DHIVEVVI'YS;8TREH _~Sc1t.eL F..e_'_____.,",------AHEA &:c,A1~__QUAD -~------TYPE ..BOa..;.'.-------FORMS ...$~lM.W-R,.9NOTES ,-- <br />-The undersigned hereby appliesfor permission to excavate,construct and/or othelWlseencroach on Counly Highwa Right-of-Way on <br />the I1JE side of S'''./f\.+t:t.Fe l?d approximately.>O eell lie S IE-' <br />of .$•1-18•.•.e>ld t4.ue.,_-_~t£4ctf.l.aJlJ ,by performing the following work escriptlon of work):, <br />Lrn 2.&';;.3 <br />Work will commence on orabout',1.2.-1'1 -1£forapproximately_~t-=.2.=-<.O~days, <br />I,the undersigned,certify that I am the owner ofthe respective property,or am qualified to representthe ownerand agree to do the <br />work describE)dabove in accordance with lhe rules and regulations of San Joaquin,County and subject 10inspection and approval. <br />-Ud~A ~~r 'Signature of Applic~m"Title <br />I.tlCEllffiALSER\'1CeS\CLERJCII.l.IPUIl-SV.\v,{\'1AS'lT:JU>WllCROACHl/,EllT fER//JT /,PPUrillTIOllDOO {llS'/13) <br />._lId 7 ~.J.6I~ <br />Date