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.-'0 •~ <br />. <br />AIPi'UlGlfllliji\!j FOR IENC~OJ.I\,IGHI\i!IEi\!Jri'1E~rr <br />OFFICE USE ONLY <br />JOB #1300 'fd..-Iu REF;!! <br />APN CR# <br />EXP.DATE i1/f'd-J4 DRIVEWAYS:VAliD,3£!O~I(P <br />"STREET Mi. <br />AREA ~C,UAD * <br />TYPE • <br />FORMS ~~IIlQ~ <br />NOTES <br />2.CP/t <br />To:San Joaquin County <br />'Department of PublicWork$ <br />'(;1£PM 3.12D (,7 C((; <br />{.I\/PiuHiC<!;itll~~l11e) <br />'1oLto t{).~s't k."e <br />(M<JlllliU1!j.l\iJIiillress) <br />5.>'tl:i dc=-E:'H'i "elf q~::l..C>'1(Ci~y,S~a!e(Zipi Collle) <br />(;z erq:J 3"1 3.-qt.I-3'.z.1Area ClIde-I eHepl'1!n!!\l1lllU~er) <br />Sketch (Det@ledplans may be submitted) <br />,The undersigned hereby applies for permission to excavate,const~e and/or otherwise encroach on County Highwa'Right-of-Wayon <br />the,5 side of VJ A-rM 6i,,-p'lII;}«approximately "1 D eetl He II) <br />of La/!HW ',;AI eo,..tl VV\e "'-t ,7 Bt'l ,L b f>::r;,by performing the foliowing work escription of work):, <br />WorkwiJI commenceon orabou!7-lfj -2bl1t -forapproximalely .2 'days. <br />£rJ'O !1-::u;-:Mt6 ',I,the undersigned,certily that I am the owrer of/he respective property,or am qualifiedto represent tile owrer and agree 10 do Ihe <br />"work described above in accordance with Ihe ruies and reguiations of San Joaquin,County and subjecllo inspection and approval. <br />!Z~DrA"~Sig1J@t!lre of Appiic@nt"Title <br />M:1CElllRAlSfRIJlCEsIGlERlCAl.,I!'IlB-SV.WKIMIIS1ER.PSIEUGROACHMENTPEfl,YJr APPLIGATlOH".uot:{W113} <br />7 -.:..5'-;;<0 t /' <br />!Jate <br />II <br />iII!I