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PLEASE PRmlf: <br />Da(e to ~?.7-.20 It <br />"';:-co -,-,[)'","'",..~_u,_.I.I.;UL.:L.!i..:~1uRK~ <br />OFFICE USE ONLY <br />To:San Joaquin County <br />'Department of Public Works <br />P&ie=.Po""'.3ng 1-/'-103 <br />IAlJiiiic~ril r~mile) <br />/..-to Llv Wees.-+L t'u,,,e., <br />(Mamll!)AillHress) <br />...........~t"c,k ...•."V\.,C/''\-Cl '22 (9'{' <br />(Cily,SI~te,lip Coll1e)b2tJ~I)~7;:S~ell/:5'~rXul2.eIre;,&ie" <br />,(Area Gode •I eNeplJlJlle miHmIJer) <br />Sketch (Detailed plans may be submitted) <br />JOB #73(;05()..-{...REF # <br />APN 'CR# <br />EXP.DATE 'I'~~ <br />VALID,M..,'(0 /1fL/& <br />STREET ¥f,-~y,,,hi.' <br />AREA U>dt .QUAD Alb <br />TYPE ,&k RfiirJlLrJ<Rrtl- <br />FORMS %,-J <br />NOTES r ' <br />DRIVEWAYS: <br />,The undersigned hereby applies for permission to excav.ate,construct and/or otherwise encroach on County High~Right-of-Wqy on <br />the g side of DW;Ttll\~t:1 ,approximately:::2 /6 ~mile __/II__ <br />of G Pe 1-+te.r I?4 ,L 0 D::t..,by performing the following work (description of work):, <br />Work will commence on or about 7-1B-20 i6 for approximately "Z..days. <br />~Nj)11-~Cl'-~O it' <br />I,the undersigned,certify 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 witll the rules and regulations of San Joaquin County and subject to inspection and approval. <br />AJ!WIA_t Dc~ <br />SigrmMe of Allpiicam "Tille <br />WCENrAAlSfRvrCE'SlCLERlCAU.clJlJ.SV.W.~\\'!ASlERP.sIE1IC:RDAClfMENT ~EfW,rr APPLICAllO[.LtJO[;(iJe/13) <br />6-"-:47~~i:J /6' <br />vale