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f <br />,,"1~J'!p.!27 f'ri 3:[',3CoilIU~,\~. <br />Dale <br />PLEASE !PRIM!: <br />6-').,7-.2CP/t <br />To:San Joaquin County <br />.Department of Public Works <br />f&iE A'13,1l83B26 <br />IAplJlieali1 "~ame) <br />!.foLio tV'G$f Lane, <br />(MaiHirnll AdI<dImss) <br />:;;t 17 t:k -f:oc'1 .,(5 fir q57"-2..0 tf <br />(Cily,SlfOlle;Zip Cll()]e) <br />L2e1J 57?'-1t.f 5 <-lAm@ Gode •I eiepIJorne I\fIUl11!Jer) <br />SI<eich (Detailed plans may be submitted). <br />OFFICE USE ONLY <br />JOB #13005J-&>REF# <br />APN CR# <br />EXP.DATE ..111(1"VALID.l!'ifIJ",r;:;,1/0£;DRIVEWAYS: <br />STREET 1t)1t';:';~k~I f: <br />AREA ¥~~QUAD ,if£- <br />TYPE * <br />FORMS <br />NOTES <br />.The undersi9ned hereby applies for permission to excavale,construct and/or olhelWise encroach on County Highwa Righl-of-Wayon <br />the;:side of Ne tUhl'Te L""i!L€..approximately I'emile S- <br />of 5~a=e:;.::"Lr .,Sf"tJc:tt;UI .by performing the following work description of work):, <br />Re.eUIC;e,De+er-tot~,d'ed P",(j.>I <br />Workwillcommenceonorabout "7-'B -2bl6'for approximately '2.days.ErJDll-?-O-2bt-l . <br />I,the undersigned,certiijl that-l 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 ruies and regulations of San Joaquin.County and subjectto inspection and approval. <br />&~DCA ..•:...SiglmWre of Applicai1t.Tille <br />WCf}{JRAlSERlllcr51GLERlLAI.IPUB-SV.Wl(1MASlEft.PS'.8;'~RO,\CHMEHT PERMrr ArPliCATIOJUJOG (09/13) <br />'-2 ')~;;<61/ <br />D@le <br />"I <br />1III <br />I