Laserfiche WebLink
Date 2CP/6 OFFICE USE ONLY <br />To:San Joaquin County <br />-Departmenl of PublioWorks <br />PG-~E PM site 3q &;3 <br />~!\ppiica;i~n~ami9) <br />'1tJ!LII)4J.~S't LiI€f!le., <br />(MaiUilDJl J.\.!ilrdri9ss) <br />~T:tt ~.J<--f:tlPi "ddt q~:2..O'q. <br />(CiltJl,5~"le;ZiIliCo<Je) <br />(2(lqJ 37~-it/--~.2."{Area tllile "JeieiJllJlJlIIl!!\i'1IIJm~erl <br />Skeloh (Delailed plans may be submitted) <br />JOB if 73(}()')d-~ <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF # <br />GR# <br />DRIVEWAYS: <br />.The undersigned hereby applies foi permission 10 excavale,construc and/or olherwise encroach on County Highv~ighl-of-Way on <br />lhe til siele of ~A tI'!IVt s-t ''''r\.'approximalely I?II ~i1e U) <br />of FlUb ,-y.V>.Rd L.0 /)::c ,by performing the followingwork(description of work):, <br />Work wiiJcommence on or aboul 7 -If)-2btt{-for approximately :z days. <br />.Efl)'O 11-:u;-2bt£..I,the unelersigned,certiji,rlhat I am lhe owner oflhe respective properly,oram qualifiedto represenl lile owner and agree to do the <br />work described above inaccordance wilhlhe rules and regulalions of San Joaquin.County and subjecllo inspection and approval. <br />7 -P -;;<61,{ <br />l!Jale