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"~~'-.;..;\!.:l;S /\lIt .'J .~;:~;:;;cU ',.:;'l T Y <br />2Di5 JUr.j20 Pi'i 2:!,O <br />AIfJIf'LHICATIIJiI\!m~IE!\JC~IOJACMMIENrIf'IEIRliIln"L i','.(;:,L ,f L f (;\y 0 i~f(S <br />OFFICEUSEONLY <br />JOB#7'3cx;5~4.REF# <br />APN CR# <br />EXP.DATE /t~ <br />DRIVEWAYS:VAliD.n~':C;({11k <br />'"sTREET N/!N~Ad f :~AREA ~~QUADJTYPE"/~¥~.FORMS 1/wdNOTES <br />Ii OLIo tVe-si'L,<t&>'Ht111.ij~n~mllAilillress) <br />5>-ttl e.k1:ot'l 4 6#t 15~e>«.f <br />.(CiIY,Stnle[ZilOl !Collie). <br />[;zoq1 375,-1'1-.$Z(Area .!Code.Telephone I\fimloer) <br />Sketch (Detailedplans may besubmitled) <br />PlEASE IPR!I\II: <br />Date J!:~OZtM ~.2CP /6 <br />To:San Joaquin County <br />.Departmentof PublicWorks <br />t)I j IC 11 9>,'\,,,.Q C~~I_,,_J7 ('C r""1,.;;".,.!,,'",Ce'• <br />If\pjJ~ic~lilf~ame) <br />.The undersigned hereby appliesfor permissionjto excavate,construct and/or othelWise encroach on County Highw'.lght-of-WR\fon <br />the Ea$1...side of Fe "''',.I1/00d Av"-.approximateiy'7 ee He /II <br />of ..G A ~Ii.I t%l .L IV >"+,1(;It::t(l9'Vperforming the following work escription of work): <br />, <br />WorkwiJlcommenceonorabou!7-£-2.btK forapproximateiy_~~~~~~_days.ErJD 11~1S--.2bt6 <br />I,the undersigned,certifythati am the owneroftlle respective property,oram qualifiedto represent tlle owner and agree to do the <br />work described above in accordance with the rules.and reguiations of San Joaquin.Couniy andsubjeclto inspection and approval. <br />&41 OrA":"Sigl1@ture of Applicallt.Title <br />r;;-?P -;;:<0I ,{ <br />Date