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Date <br />PlEASE PRINT; <br />I ~>~.2.CP/t OFFICE USE ONLY <br />NG <br />DRIVEWAYS: <br />REF # <br />GRit------- <br />JOB #73009--(p <br />APN <br />EXP.DATE -~--~--~---VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />To:San Joaquin COunty <br />.Department of Public Works <br />P&~E PM 3ltfFF!16 <br />iA~~liG~litli~a!i1e) <br />'1oLlo tcNiS't we <br />(MlliUii1!J)A!!IiiJJress) <br />~'f;p ek -ted'!,eN q~::£.cif <br />(Ciltjr,StnlerZll~Colile) <br />{,;z"qJ 37!>-q¥-3 ~iiire~iGmJle •I eUe~lllJi1e fJilm~eij <br />Sketch (Detailed plans may besubmitled) <br />.The undersigned hereby applies for permission to 9J~ate,construct ,mdloroth?JWise enGroa?hon County High",j~Right-of-Way on <br />tha \;1./.Side of I\)~&t--t-.c Lan e-iQ.d approximately 913 L!~mle N <br />of E ~arq ~,l\'t I?d ,4t.k.e t;:-G'1"-<1 ,by performing the following work (description of work): <br />Re.elM:e 'OErter-to crr1'ed Pde.1&71 s=N ::r«.c..K-'l(J.'l~Rc:lI <br />, <br />Work will commence on orabou!7 -If)-2.b{{t .for approximately 2.days,E p,J '()/1 -;;J..tJ -2b t6'., <br />I,tha undersigned,certify that I am the owner ofthe respective properly,or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of qan Joaquin.County and subjectto inspection and approval. <br />~t\[l.ENmJ.lSER\IICES\Cl.ERJCALIPUB-SV.wI\llJASlER.P.sl8.j[;IWACH!l.BU PERMIT APPLICAlJOH.lJDG (0&13) <br />" <br />I! <br />i <br />II