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,",'i ~.. <br />S I~r~.}:..:;~(.J ;,,;!:":C C i..;f<T Y <br />PLEASE I'RUlli;. <br />Dale OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />PGiE PM 310/.2'117- <br />IApl'liicmit N8i1J1e) <br />4.alfo We,..~t ~ne, <br />.(I\IlamH1!lAiIId~ess) <br />.s-iobkfOl'\.('.,A q5':2.0Lf <br />(City,S(~t(!,Zip Code) <br />I?l9q)~73 -q'l3~rx:j2€D-j.pu~ <br />(Are@!Code.ifeHelllJolle Nl!rnbe~)r ilj <br />Sketch (Detailed plans may be submitted) <br />£ee--Ske-T~ <br />JOB #'13oo5o..-i.c. <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />1 'I ,a 1'1 CI qcPO ~ <br />8i.Lerer Rei <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroifch on Count)'Hi9h!,Ri9ht-of-way on <br />the r=:side of r=Gt!4la/\Betl{yl:a &1 approximately 35 N,qac/.i:e ile _ <br />of {3bt c e\-&d ,,by performing th~fo!lowing worl<escription of work):?tit~;t:1¥N-~~ZZ-~&f:16-p,p H~.mj7 --~ <br />Work will commence on or about 7 -/~-z "t 6 for approximately Z days. <br />GIVJ)It -::l./J -~o 16'.I,the undersigned,certHy that I am the owner of the respective property,or am qualified to represent tile owner and agree to do the <br />work describ~d above in accordance with the rules and regulations of San Joaquin County and subjectto inspection and approval. <br />~Q/..••..\ <br />SiglJ~lure of Appiicallt -Title <br />l,t\CEllTAAlSER\IlGESlClERl\.JJJPU!l-SV.WK\MAS1ERPS\BICROACIw.El~rPERI{.rr APPLICATlON.OOC (00113) <br />;;-3cJ-.2Dlb' <br />Dole