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2u1GJU:cl27 Hi 3:l:3 <br />OFFICE USE ONLY <br />JOB #'17a65•.•-~REF# <br />APN CR# <br />EXP.DATE 1,I,Ii(" <br />VALID 't/rRI,1..>TO /lId,,,,DRIVEWAYS: <br />STREET O,,<.~,,utSf,.f: <br />,~REA ~(JoJ~QUAD tJW , <br />TYPE , <br />FORMS ;;t.tj~ <br />NOTES <br />4oLto cVesi'La/llf., <br />ll\!IllIiHirug AlNiliress) <br />~ft;ek-fCdl,6-it 15""::<.0 if <br />(Cily,SMe(Zipl Cll!JIej <br />(;<01:1 s7s.-'f¥-:5 ZtAreaCode-IIeiellhonte NliJIIl1!Jerj <br />PLEASE PRINT: <br />Date (-2.7-..2CP /t <br />ffr i £,PIl1 3.iL e t.j 213 3 <br />IAlfllJlicmi,fi\!~me) <br />To:San Joaquin County <br />.Department of Public Works <br />Sketch (Detailed plans may be submitted) <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highw.e Right~of-Wal!:on <br />the JA)side of Gh:e'"-tl'",d ..£:[.approximately 7C;;-ee'i1e__>_'_ <br />of p fr II,1'lU'+<{R J ,jO;;;;dJ,t--/pfffe,by performing the foliowing work description of work): <br />Re.pit;te De+e I'i""l'>deCl .P,.,ie,. <br />Work will commence on or about '7 ~I e -2btit for approximately 2;days.. <br />ErJO !(-.2D-26t6' <br />I,the undersigned,certilil that i am the owner of the respective property,or am qualified to represent tile owrer and agree to do the <br />work described above in accordance with the rules and reguiations of San Joaquin County and subject to inspection and approval. <br />;;-27-'::<6/l' <br />!lale <br />WC8ITRAlSER\JlCfSlClERlCALU'Ut>.sV.WK~'MSTER.PS\EljCROACI-fI!.El1T I'ERMrf ILPPLlCA110lWOC (00113)