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", <br />ow""J'!Q PI"2'I'J"!ylO .Ji h -J j~'I <br />PLEASE i'RINlf: <br />Date OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Wori(s <br />J.tr 2 E Av,~II'1 q5'8 .2 <br />IAlllllic~iil Name) <br />Lf [)Ltt2 lVeS l'La Iiie <br />lMai~ii1!lA!JJilfess) <br />:f,t f1 eJo:::--f:0 t'1 J 6Pr qs;-;<0 if <br />(City,Slllle[Zip Corle) <br />l2t>q)57.;;-'it!5 Z(Am@iClI!JJe-ifeiephollll fJlmlbef) <br />SI(etch (Detailed plans may be submitted) <br />J~~,Ii__.''l2xJ5a:<o <br />APN <br />EXP,DATE <br />VALID. <br />STREET <br />iIREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />.The undersigned hereby applies for permis ion.to excavate,construct and/or otherwise encroach on County Highw Right-of-Way on <br />the ..s side of .-~.-e;.L 4.'"..approximately :;z3 0 eet!lie E- <br />of 1\\11\;11\,1.bN Ali'S>SX"c.kif"",byperformingthefollowingwork escriptionofwork):)")- <br />Work will commence on or about b -;:2.0 -2b t 6"for approx.imately;:z,days.E(>J 1)11-is"-;2b t£. <br />I,the undersigned,certify 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 reguiations of San Joaquin County and subjectto inspection and approval. <br />otl-;::wt,{ <br />D@le <br />l,t\C8ll'RAl.SER\IlCES\C(fRJCAL\?US-SV.\'II(\'MSTERPSIElIGRO.~CHft'.EHTPEIW,rr APPlICIITlOIWOC (MI13) <br />"