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PLEASE pml\lT: <br />Date G"-')..'1 -::UJ 16 <br />To;San Joaquin County <br />,Department of Public Works <br />fbi E PV"I 311<B l-(1-19£ <br />IAllpl~calill~8me) <br />""to Llo We-s,,-f L .::u'\~ <br />(l'JI"mi1gj A!ildmss) <br />S't PC ,k '*(Hi\.j cj"\;Cj t,;_?0 ,t <br />ICily,SI~le.I'ill!Coole) <br />f?-IJ~)?'73 '-1~3<.('xcii?ef9e.<121' <br />.(Area Code ..I elepiJQJH1eNllmber) <br />Sketch (Detailed plans may be submitted) <br />2U1S JUiJ 27 Pi'j 3:':3 <br />OFHGE USE ONLY <br />JOB#13cb5')'.""'REF# <br />APN I GR# <br />EXP,DATE ,llhlt?,I <br />VALID 7!tJ'/!t.>I j()If/1l1&DRIVEWAYS: <br />STREET Iii," <br />AREA ~,"AO )/6 '" <br />TYPE ; <br />FORMS L!:flc.ce~~, <br />NOTES <br />, <br />,The undersigned hereby,applies for ~ermissio~to excavate,construct and/or otherwise encroach on County Highw~Right.of.W\!y on <br />rhe Is}slOe of AJ ::)••~~t--<"T(')I'\e,.,R.d approximately gq:;:;-~mJ[e_I::!.~_ <br />of ""'-,<;",.,,~t}!=Ow\:i~d ,L 0 f)-:s:.,by performing the following work (description of work): <br />fOi-e <br />Worl(wil1 commence onorabou!7-tB-a016 for approximately ~days, <br />t=:1'JD H -::W -26/6'" <br />I,the undersigned,certify that I am the owner of the respective property,o'ram qualified to represent tile owner and agree to dothe <br />work described above in accordance with the rules and regulations of San Joaquin County and subjectio inspection and approval. <br />AJ2a,1k~.Dt?~ <br />Sign@t!lre of Applkmll ..Title <br />l,t\CErlTRlllSER\IIGESlCl.ERJr-AllQUS-SV.\'IK\W,STERPSIEICROACIIMEl1T fERMlt APfUCA1]OI-LUOC (O!l/l3) <br />{;-:4.7-~i:J 16" <br />I:!@!e