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" <br />]pLEASE I'RII\n: <br />Date OFFICE USE ONLY <br />To:San Joaquin County <br />-Department of Public Works <br />e&i t=.PtI1 3-1 I ?3 '-/37 '1IA1'llllicarn~Wame) <br />40'-10 tV-est Lat1e <br />IMaiHili!J Aildre5S) <br />S j;{]«):<=--/:tlt'l,(jIt 15i~oif <br />(my,S~ale?lill Collie) <br />(20'1'1 37;;;-ttl-5.zlAmaCoile.1eleplJ!llie !lfIHlillDer) <br />I Sketch (Detailed plans may be submitted) <br />REF# <br />CR# <br />It:- <br />TO <br />D <br />QUAD _M~~_et!Jf{(A£~~- <br />DRIVEWAYS: <br />-The undersigned hereby applies for permission 10 excavale,conslrucl and/or olherwise encroach on County Highw'jY,Right-of-Way on <br />the N side of fi:.A ~tGlY PO gel approximately //)-2 $::~i1e E <br />of &1-;vg.1,1.tJ R(~."At".4U!,A po ,by performing the foliowing work (description of work): <br />«,,"-elate De+er-toczeted .prJ leI <br />Work wi1lcommence on or aboul 7'-)e -2Qt K fur approximately --".days..ErJO il-.AO-2b(-l .I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described above in accordance wllh the rules and regulations of San Joaquin County and subjecllo inspection and approval. <br />&J2vJL D61 "::.-Signature of Applkallt.Tille <br />ttlCElmlALSERVlCESlCLERlCAl\l'lJ!l-SV.WKI\I'ASTERPSIBICROACftMEHT PERMIT ,\PPLlCAilOH.OOG (TJ'!/l3) <br />6-27-::<.ol.{ <br />[lale