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"..I <br />"'t."):.;:i:~;L;~;;'i_16ufiTt ;.j..~.~ <br />PlEASE I"RINTj <br />Date OFACE USE ONLY'. <br />JlOrx6 <br />DRIVEWAYS; <br />., <br />REF # <br />CR# <br />JOB# <br />APN <br />EXP.DATE <br />VALID ~'l{P <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />To;S@nJoaquinCdumy <br />.Department of PublicWOIt-s <br />~b-~is f!f'i\3 J 17.>4 b3 <br />(it~;1kl:,,~f<f';:~lHl <br />.$t~eh:""(~,1"u D e,.')t q~~tDL:.. <br />(eDity,SiOite,Zip Co!lle) <br />(;;.~).ri~-qtt32.. <br />(Ama Cooe -felsllliooe ~J!nmberl <br />Sketch(Detailed plans may be submitled) <br />!ee a:t+"i.ehe4 <br />The undersigned hereby applies for permission to excavate,construct and/or otherv~seencroach on Counfy High~Right-of-Way onthe~<!>T'"__side of <;;r::=I D",•.•.4do .>t epproximately 7.00 ~mile S <br />of $.Fr~~~,,-....,.1d ,---S.:tockf6l'\.by performing thefollowing work (description ofwork): <br />ReplAc.e G:.~fA..V-!ire.:Oller EL Db""&;2-L••e.L1;.'"",S <br />"Tf'(!A..•fflC-y-tef('UI/-f,'''1I <:::tS "",~jA,~ <br />MoT 14 II l 0 t-l re... <br />Work will commence on arabaut J -C.•..2 c>I ~forapproximalely R";J>:-8-1-~e>I6days, <br />I,theundersigned,certify that I am the owner of therespective property,or am qualified to represent theowner and agreeto dothe <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />;"00-.:;, <br />Signature of Applicant-Title <br />.3-17 .•..::to 16 <br />Date