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2illfi JUN 27 Ph 3:[14 <br />OFFICe USE ONLY <br />JOB#1~(;5'J..co REF# <br />APN <br />lilt/lip , <br />CR# <br />EXP.DATE <br />VAliD,1J!of...I to d l/ilo DRIVEWAYS: <br />STREET ;;;'('11\1 ,iZ,D,f 7 , <br />,",REA ~Kr"IJ~" <br />TYPE •,vl~&fi'FORMS -¥vw",'NOTES <br />" <br />To:San Joaquin County <br />'Department of Public Works <br />PC:riE.PIM 31l.9f ""!'-18QlApplicaiil~ame) <br />f-.{oLlo We,~+Ltu\e" <br />(Maiiirng All1ilress) <br />'7 'f "e,k 'i<",,'"~Cr"r ea ",2.,1':)i{(iCily,S!~le,Zip Code) <br />[20~):S73 ~"'j I{SZ fX'ti/2J2 Ire;,M <br />L-~'(Ama iGllile -IIeiejJi111ile N!IDllJer) <br />PLEASE i'RllMf: <br />Dale 6'<)..7 -2016 <br />Skeich (Detailed plans may be submitted) <br />,The undersigned hereby applies for permission to excavate,construct and/or oiherwise encroach on County Highway Right-of-Way on <br />the 111 side of 5/LJ/-\Rd '.approximately ee mile E <br />of Be-e,~h es":f??i ,~,by performing he following work scription of work):, <br />{'bi-e <br />Work will commence on orabau!7-!B -:::t.<::J [6 for approximately "Z.days, <br />(5\.ij)i!-=e.b '-.46 16' <br />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 the rules and regulations of San JoaquinCouniy and subjectlo inspection and approval. <br />6<--::L7 ~~i:J {--6 <br />lJale <br />~t\CE.lflMlS€R\IlCES\CLERJCALlfllJB-SV_\'IKLiN\STf.oR.PSIElICROACHMENT PERN,rrl,PPLiCAllOI',UOG (0.91;3)