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.2(1;/6 <br />To:San Joaquin County <br />'Department of PublicWorks <br />pf:riE.PM ~It 5 L-/G20 <br />(Appb;i,Warne) <br />1.1()1LIo 4J~>"t klfPt!. <br />(MlIiUilill AiJIiIlress) <br />~1:61~kAtHfj "6Pr q5:-:z.",q. <br />(Citty,s,@w(Zi:rn Collie) <br />(;zUqJ 37~-'1tf~2.-iJ\re@Gi»de ...I eieJll!Jlllle !\lOOiliJer) <br />Sketch (Detailedplans may ba submitted) <br />OFFICE USE ONLY <br />JOB It 13005J..-<"REFit <br />APN CR# <br />EXP.DATE ./1/'«&VALID,1ftg/tV ri /(/tIt~DRIVEWAYS: <br />STREET ~1£~1(~~'" <br />P,REA *tA~'QiJMC/iIi <br />TYPE ,4&hpb«<, <br />FORMS 95/wvJ' <br />NOTES I <br />'The undersigned hereby applies for pemission to excavate,consrru t and/or otherwiseencroach on County Highway Right-ol-Wayon <br />the W side 01 IV 3't<.de-"'TI',,,-_approximately 7 emile 5 <br />ofE:V',.-"'0 ,L",c.Jc;-efo r-c/,by perfoming the following work escription of work):, <br />WorkwiHcommenceon or about 7-If)-2b t t(,for approximately 2...days.,ErJ'O II-:;w -26t£'_I,the undersigned,certify that Iam the owner ofthe respectiveproperty,or am qualifiedto representthe ownerand agree to dothe <br />work described above in accordance withthe rulesand regulations01San Joaquin-Countyand subjectto inspectionand approval. <br />7 -5'-::<6/l' <br />D@le <br />"