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... <br />PLEASE PRINT: <br />Date 6 -1'7=2.0 It <br />To:San Joaquin COunty <br />.Department of Public Works <br />Rf"1 -3 It eFl 5":z 7 <br />!A/lPHc~li[n~"m"l <br />--.!i12.t..i.o W est L&ti'JC, <br />(Maml19 AlDillress) <br />5>-to 6k:t>Of\,6A-qhc;;it <br />(CultJl:St~te,lup Cllile) <br />Sketch (Detailed plans may be submitted) <br />I <br />OFFICE USE ONLY <br />JOB#'1%G;)"-<.p REF # <br />APN CR# <br />EXP.DATE ----;-I.-d~,~/,~~;::-- <br />VALID.¥ffii;.!'fa /I !Iji; <br />STREET ~o/.---.:.I _ <br />AREA i QUAD /lI/l <br />TYPE .Wct~ <br />FORMS <br />NOTES <br />DRIVEWAYS: <br />.The undersigned hereby applies for penmission to excavate,construct and/or otherwise encroach on County Highwa Right-of-VVayon <br />the r==:side of N 'T Lkll ~Rd.approximetely 2.'0 e 'ile ~N__ <br />of £5:tl r-~"wi'I<.d,Lo D;I ,byperforming the following work escription of work):&:p ltil re-U>e.+en',;.ud:ed 11>Ie;. <br />WorkwiJI commence on orabou!7 -Ie,-=cN6 .forapproximarely .:z.days.e rJ.{)ll-:,;2.0 -2.6!t ,I,the undersigned,certiji,r thai 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 />~~ <br />Sign~t!lre of Applic~l1t •Tille <br />~t\C5\'TRALSCR\liCES\Cl.ERlCA!JPUB-SV.I',1~\\!ASTEltPS\E1ICROAGfIW,a1TPERMrr APrUCAl101WOG (Mtr.l) <br />6~27-2Dl6 <br />Date