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t;,,,-_',.-.;\:j.Csj~~(j '~I;':,.(j U :r.."~,U t;H T -l <br />2U16 JUN20 Ph 2:4 [J <br />AIPI'UC.i-n~OI\j flJiR IEMCROIACHflillENT1PlEIR!\IU[;L i':'"i ,-'Du::\','0 in;s <br />PLEASE /PRINT: <br />Dale ,-7::0 -..2a>16'OFFICE USE ONLY <br />To:San Joaquin County <br />-Departmentof PublicWorks <br />IJ /.4 r A.~!~t'"jJ/"('j,/Lu:L c::.t\li '''''''~;;e,.",,,,,,,,)(t,;)t."I <br />1J\T)llluca"i~Mame) <br />q(;ILtO lJ).esi'La,'lt:. <br />(Mai~iln!lllllljiilress) <br />S-b"(:1<--i:(.),;1'1,6ft qs;-:::to if <br />(Cily,Stale!Zil»Coiile) <br />[:2bq)~7?'-fl/-s <-lArea Clliile ..Teiel»!lOIlleNllIiIliJer) <br />Slmtch (Detailed plans may be submitted) <br />JOB #7/.4d5J.--Co <br />APN <br />EXP.DATE <br />VA.LID . <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF # <br />CR# <br />DRIVEWAYS: <br />-The ung,ersignedhereby appliesjor permissionto excavate~cp'qsfructand/or otherwise encrmch on County Highwa Right-nf-Wayon . <br />the ~_side of ';>+~'r.M.\5\"-.\1.1;;1.l<.d approximately /2.£7 ee lIe_Sotl'""''''' <br />of ----J .'(Pd\;'\i.er 6::\"'0 lie ._.w &(1."'1;Cr,,,,.felly performing the fOllowingwork escription of work):ielI.I <br />Re.eWte ))der-t't>C4:ted.e;lPI <br />WorkwiJIcommenceonorabout_7.~y -2616'for approximately ~days.EroJD/j'-iF -2bt-6', <br />f,the undersigned,certilY that I am the owner of the respectiveproperty,or am qualified to representthe ownerand agree 10do the <br />work described abovein accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />!Z~.JL DCA"::..Signature of Applicalli ..Tille <br />"