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<br />(!{,!"..::,','.'~,r,,:~:~,"'.'.C D U I~j~\;.~,:--,-,
<br />PLEASE PR!I\IT:
<br />Date 6-?-i -2016
<br />2fi1G JUi<l 28 i\fCI iO:i
<br />GE\)-j-,Vi ;-UBL\C \('iO
<br />OFFICE USE ONLY
<br />REF#
<br />CR#
<br />JOB#
<br />APN
<br />EXP,DATE
<br />VALID,'1 is'Ito TO II I 1(",DRIVEWAYS:
<br />STREET '0 ~A.k-"
<br />AREA £'5?<,-l&<QUAD 2E..'.,
<br />TYPE ~fie/!';,.&/(6"{ktJ)Cf~
<br />FORMS ~~'t<-W _
<br />NOTES
<br />P&#E PIfYl .f,iot2Qt7IApplicali,l~ml1e)
<br />To:San Joaquin County
<br />.Department of Public Works
<br />l-lb ~!O w e.s.+L ,,-,,\.e.,
<br />(l\!l~iHii1gA!J1rdi,ess)
<br />$'t"tjk '4 t1"\,ci'\-q 9'2 Cll{'
<br />(Ciiy,S,~le,lip Cordle)
<br />[2tJ ~')?,73'-'qIf :5'z f'x"til2.ef9e:.&:1l
<br />\--(Area Code -IfeHelfllJoile fJl!lIIIoer)
<br />SI(etch (Detailed plans may be submitied)
<br />.The undersigned hereby applies for permission to excavate,construct snd/or otheJ1Niseencroach on County Hlgh~a Right.of.Wayon
<br />the G side of JL.'c!.-T~U¥Ave..approximately (;S-O 'T70 ee He ;V
<br />of G.R tJ!85:,gtJ!,,by performing thlfollowing work (esciipITon of work):I --~,-----
<br />Deie.r-i'bNtThtO c..r~Uirl\ll,;?,60<'-,13Ft?-cd 77/2r;:.(-(,'ver &l,pl<rh'CTa'y &lye £;Slde."
<br />Work wili commence on or abou!7-iB -;:1.(9 \6 for approximately A 'days,
<br />.(2"I'Jj)i ~-.::Li'J '-2,,0 I{.'
<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 sbove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.
<br />M,.,,,,1 D~
<br />Sigl1@!l!re of Applic@nt ~Tille
<br />6'.-=:2.f-~tJ It;
<br />iD@te
<br />~tlCENTAAlSER\IlCl:S\ClERlr""LtCUB-S'J.WK~.lASTEIl.PS\8fGROACfjMEl1T PERI'l,rr APf'lICAllOIlDOC (1J!l113),
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