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2ulG JUii 27 Prj 3:I.:3 <br />PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To;San Joaquin County <br />.Department of Public Works <br />e&i t=P"1 3,1/8 '3 7 7 tj <br />IAPlllic~'~1n~@me) <br />4(/Lt CJ eVest L&1.lilf", <br />(M@i1ii1!l AlHdmss) <br />!?tv ckfeHfi d 6ft-q.t;::<.o if. <br />ICily,SI1lle:Zi!!Coole). <br />(2oqJ s7s.-eeL{5;ZlAmaiGode•I eie!!lJlJi1e !\lllmber) <br />Sketch (Detailed plans may be submitted) <br />JOB #1$::JJ19'(P <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF11' <br />CR# <br />DRIVEWAYS: <br />.The undersigned hereby applies for permission to excavate,con,struct and/or otherwise encroach on County Highway Right-of-Way on <br />the i side of .G t-Iit •••••11 e';;+&1 approximately .r>>"ee lie E <br />of N.q 1.,r r "••••'"a0e Rd E,A-CfV/\1'pi?,by performing the folio wing work escription of work): <br />Re.eltte:e.De+er-torzcted'P,.,leI. <br />Workwill commence on or aboul 7-18 -2.b 16'for approximately :..days.ErJD 1l~2.0 -;u;t£. <br />I,the undersigned,certiiY that I 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 rules and regulations of San Joaquin County and subject to inspection and approval. <br />&~DCAA::"Sigi1@wre of Applical1t -Tille <br />!,t\CENTRAlSER\I1Cl:S\ClERlCIllJJ'lIS,s'J.WK1.\!IISTERP£IB<CROACHMEHTPERMrr API'L1CATlOIUlOG [lI."l,3) <br />b-.2 /-::<6/tf <br />!Jale