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~.'.~ <br />OFFICE USE ONLY <br />JOB #73i1()!>J.-t"REF # <br />APN CR# <br />EXP.DATE Iflt/lip . <br />VALID _7Mli'"'Tb.!lfllfl'DRIVEWAYS; <br />STREET '(Jk/c tMe Rd '" <br />AREA ~dr'QUAD !tI6 * <br />TYPE ~Aflkmed , <br />FORMS ss/MAJ <br />NOTES j <br />q~LltJ 4J~S"t fu,~e <br />(l\IlaiHi'~!l.l\dIlI!fessl <br />5>'ttl ek of I>Jfj J ePr q~:2.0'1 <br />(Cilti',St.larzi/]Coole) <br />(2e;q]37~-If¥-~.a'I.I\ma Cilde -I eHeJlltnll1l16!\i1mJl~afl <br />Sketch (Detailed plans may be submitted) <br />I <br />!'>r:e-J'.i:e"tt-h <br />!'lEAS!:Ii'RINT: <br />Date 7 ~J,-~-2./1l/6 <br />To:San Joaquin Cciunty <br />-Department of Public Works <br />PG-~E.PM 3,\~B Ll~2 {; <br />~Apptiic~mitfi~~mel <br />!! <br />-The undersigned hereby applies for permission to excavate,construct and/or oth?lWise encroach gn Counly High~~R!ght-of-VY'3Y on <br />the !JJ ._side 0\IlL T a-<'Jk:T~approximately &,qq ~mJ1e_Rl__ <br />of C.,..rat:';{.<:<-'AGI 4;1 ,~'1M ,byperformingthefollowingwork(descriptionofwork):I _ <br />ReelA(:e,Oe;ter-tc.c>'cted -P",,{e./::J..-::2.q5 N ::sa ",k TOile M, <br />Work will commence on or about 7 -'8-2b t tr .for approximately .z days.ErJO 11-;u)-26t£-.J,the undersigned,certify that I am the owner ofthe respective property,oram qualified to representthe owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin-Counly and subjectto inspection and approval. <br />!Z~Q("A ":-,Sign@tllre of Applic@fjt.Tille <br />'7 -.>-::<61/ <br />/.lale