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!. <br />ryo~'b J"u;'!-q C;,;').'3I.U,,I~..I I II ,-.I •••. <br />P'-EASE !'RlMI: <br />Date OFFICE USE ONLY <br />LV <br />DRIVEWAYS: <br />'* <br />REF# <br />CR# <br />J08#7~iJ,..(p <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS 56J~LU~iVJ~_ <br />NOTES <br />lioLtt)eVe-Sf Lab1'f- <br />(l\lam~!l Ad1«IJressj <br />,s tIe ck.of (H/I ,6-f\(15-"--::<0i.f <br />.(Ci~y,S~~le(ZilJlCode) <br />(:2 Qq)s7:?:.-1lf 5 :< <br />(Arei!Cotle -I eHelllhiJ~e mlffillber) <br />To:San Joaquin County <br />.Department of Public Works <br />~&it=.A'I 310f i!J-7 I <br />l/-\ifl~licmil n~E!me) <br />Sketch (Detailed plans may be submitted) <br />.The undersigned hereby applies for permission to excavate,construel and/or oth~rwise eneroa~h on County Highw~y Ri9ht,~f,W_,ayon <br />the rJ side of Docu1--lcr '7"itt ._.approximately 3,.:2..-ee'mile~W~_ <br />of Pt<&J"S::I<:"Ave _if ,btt76I':'-tO'~,by performing the following work escription of work):, <br />Re,el.ace p(~+E'r-t,oc-,xtec!U'J&"":_~r;~'--~U~!~''-t~e~~;~_ <br />(~In{>\*y--f't ~ett .;;:~"cee <L--i'*12.f <;'to cAe::.ior\) <br />Worl<wiJIcommenceonorabout 6 -::LD -2bt6 for approximately Q.days. <br />!=:TL'J 0 iI -2-d -2b fr6I,the undersigned,certi!}'that I am the owner of the respective property,or am qualified to represent tile 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 <br />I <br />IZ~Du,.A;;'SiglJ@Wre of AppliG@nl-Title !lale <br />~t\CEl<JRAlSERVla;S,CLERlCAl\PUll-S'J.\'JI(~.u1STERPSIe~GROAC~81T I'ERMrrAPPUCA.T10H.lJQC ~113}