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')n"l'lt'')7 f)"",I ')LtilU •..•u~t..f (J J:},J <br />Date <br />PLEASE PRiNT; <br />(-21-..2CP/t OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />PiriE 11''13,ll'116"£"tj <br />IAplQllicalill~t!jJ1e) <br />lj 0 LtI)tV-e-S-t L.,c (Ire, <br />IMaillii1!j Mllre5s) <br />S t I:?I::J:::.--tt.H'1 d 6It-1S,---:::to if <br />(Cily,Slole?lip Corne) <br />f2.t>ql ~7s -itf 5 ZlAreaCmJe-ifeie[pll1oller'!!IilifJer) <br />JOB#73~o$';l.-CJ:> <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />DRIVEWAYS: <br />'" <br />Sketch (Detailed plans may be submitted) <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wa¥on <br />[he F?side of N Tu II ~&,£..'approximately a .;;;;.feetl~__I'J__ <br />of 8,2 k e-t--&\,L.-t '1\(:1 ev\,by performing the following work (description of work):, <br />Work will commence on oraboul 7-/{fJ -2.bt6-for approximately :z..days. <br />£100 11-;:2..0-;2btt', <br />I,the undersigned,certiJi{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 with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />6-2.'7-::<ot tf <br />[late <br />IZ~DCA .•:...Signature of Appiic8rJt"Tille <br />~t\C8<rAAlSER\IICES\C!.EruCAl.\flUB-SV.WK,\lASTER.PS\8,GROAGHfl.Ellr )'ERMIT APPLICAllOI.WOE;(~113)