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'~'.L,S /"(.j J'J;\~,.~;.,1 ;,'c:C ~,~'.!T ''f <br />2tl1HJlHi29/,;i"110:08 <br />To:San Joaquin Gounty <br />-Department of Public Works <br />1&h~>Pbli 3 IJ 7 7().30 <br />IApiOli~a!i1ti~ame) <br />t{t!~o we-t,t L~.J\e <br />(Mamllg Miilire5s) <br />.s:-t Der-:--to I,,~f\q£"~0 '-I <br />(Cili S~~l",lip Colle) <br />(?otf}n 3 -ct'3 fx'd2@!..eo,d6',"-1 <br />(J\m~Code -ire!epl1olle 1\l!Jll11!:Jer <br />OFFICE USE ONLY <br />JOB#1StxJ~J.-'(,;,_REF# <br />APN CR# <br />EXP.DATE 1I!tI11.' <br />VALID 111l1r~I 'TO 111t/1I;>DRIVEWAYS: <br />STREET 'l,;;'c1Dr Aile--,'==JAREA5&4<-1611 QUAD liS , <br />TYPE t7./e f:JJlca ..•....•4 , <br />FORMS +-INOTES <br />- <br />Sketch (Detailed plans may be submitted) <br />-The undersigned hereby applies for permission to ex~avate,construct and/or otherwise encroach on County Hi9~Right-of-Way on <br />the fA J side of N~IA ~'/a,:(',4-1)1 E approximately /6-1 emile S . <br />of.F:/vi t)c-t,le/~+~',~--t:aeAc+ofl ,by performing the/oilo~ing_,work (description of work): <br />1?.~l4:.Cct2 De-ter,or--a:r-e.ei!.&Ie ,I.?I N;~Nl-td4t"" <br />Work will commence on or about 7 '-\I -;2..0l6 for approximately 2.days. <br />IE.tv j){(~;).0 -2.01£''I,the undersigned,certify that I am the owner or the respective prop'1frty,or am qualified to represent the owner and agree to do the <br />work describEid above in accordance with the rules and regulations of San Joaquin County and subjectto inspection and approval. <br />~D~~~,Sigl1Olt!lre of Applical1t -Tille <br />~t\CffifRALSERVlCES\GlERlCAL\f'U!l.sv.l'm.\tASTERPS\8jCROACHl~8H?ERII.rr Al'PlICM10NJlOC (OOI13) <br />6 -,21"-2.b!6 <br />i);;le