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'u""I 0"1'lu'\!?7 I);,l ').I,3•..,,«L I II •..1'"? <br />Date <br />P!.EASE PRINT:,l-;2.7-.2CP /{OFFICE USE ONLY <br />To:San Joaquin County <br />-Department of Public Works <br />3'..&i £.A"I 3 tli()4~BLL(1-IIPIl!ic3,i[lIIame) <br />L{OL{tJ tV-e-si'LaM: <br />lM,illil1!l Aliidr\J5s) <br />S 1:n e:)<..-ftH'1 ,,6/t q5>~::<0 if <br />(Cily,Slale?Zill Cllll1e) <br />f20'71 s7s.-10 s Z[Area ClIde ..TeielllJlllle IIIlfflliJer) <br />Sketch (Detailed plans may be submitted) <br />JOB #'Bt»5J.--(q <br />APN <br />EXP.DATE <br />VALID, <br />STREET <br />ARE~ <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />-The undersigned hereby applies for <br />the AJ side of <br />of 1\1-e'"*9'''Ad, <br />ermis~ion to excavate,cOllstru,t and/or otherwise encroach on County Highwa4:Right-of-Way on~-ev ~~Cl approximately ;<0 ~ee'mile 1=>1::0 <!'i:s:tot1\,by performing the following work escription of work): <br />Work will commence on or about 7-I 73 -2b tit -for approximately .days.ErJ'0 H -;;2(J 2btl.'I,the undersigned,certify that I am the owner of tne respective property,or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San JoaquhCounty and subject to inspection and approval. <br />\ <br />/<.,'/IJ Q ..~('A.AHSigl1atureof Aplllkallt ..Tille <br />~l\CElffi<!\lseRvrCES\CLERlCAl\PU!J..SV,WK'MASTER.~SI8.jCROAGH.~ElH PERMff APPLTCAllO:WOG (iJ!lIl3) <br />6 -;;q-;:«()!,[ <br />I!Me