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00,.0 \'"J ?7 ')\1 ?[,?£ulti ...-UI~L Ii f ,.j'~u <br />Date <br />"lEASE I'RlIIII; <br />b-.2.7-..2CP /t OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Pubiic Works <br />etr?£,11"1.3 I I g 3 76 2 <br />(A~plic~"il~ame) <br />!.foLIo eVesi'l.d/l1e- <br />IM~illii1!lAililress) <br />f;t 17eke of:ot''l d t.~It-q5>~2.0 if <br />{Cil}!,SI~le!'Zi~Cilde) <br />Simich (Detaiied plans may be submitled) <br />JOB 1/73cosJ.-ta <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CRI/ <br />DRJVEW/WS: <br />, <br />.. <br />.The undersigned hereby applies for permission io excavate,G')Wruct and/or oillelW/se encroach on County Hi9=i9ht-of-way on <br />ihe E.side of 1\20 (<().tkJ.lie.approximately I .37 S-e.ile ;V <br />of e?;t.e •eli 0 't ::;:E-,'$"[0 ")cT~1\J ,by performing the following work (description of work):,'NY70 .. <br />Re-euu:e Pe+,or-t"c,;,ded'P,.,leI•. <br />Work will commence on or about 7 -I e -2bt 6 for approximately .2...days.E IVf)({-..:2.Cr 26 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 with tile rules and regulations of San Joaquin County and subjectto inspection and approval. <br />&J2J D~--=;;..,,----_Sigi1~!:IJreof Applicalll-Tille. <br />6 -27 -.::<01 tf <br />!}~!e