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Date <br />P!£ASIE PRINT: <br />7 -s-~.2.~16 OFFICE USE ONLY <br />To:San Joaquin County . <br />.Department of Public Works <br />pG-iE..PM 3\18 L{38~ <br />1.l\1ljl1!iC~rlltn~ame) <br />1.1oLto W~>-t k.~e <br />(MamUlll Adlilress) <br />~'i:{;e.J<At.Hftj,iYr q~::u;q <br />(City,Stiile{lU!JjC!JlJ1e).' <br />(2:C'lqJ 37'~-q':l:3 2.-lArea iCmJle -1eie!JjlJllllle !I11!111!Jer) <br />Sketch (Detailed plans may be submitted) <br />JOB #73009-<'" <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />DRIVEWAYS; <br />.The undersigned hereby applies for permis2ion to excavate,construct and/or oth?rwise encroach on County Highw3lt R!ght-of-\!!{?yontheN.side of /l-tk.'&1 0{f\R4 .apprOXimately 7/0 ~flIle .E <br />of gi1-ltold ~cf ,f}-&:lv,,!Pc),by performing the fei/owing work (description of work):,i <br />ReeWee.:De:h:'I't'"r>z-ted'trite 1'3",66 )'f'tkitlSCXl\I <br />Work wiHcommence on orabou!7-lfJ -212ft{.for approximately 2.days.EMf)Il-;;u)-::wt£..I,the undersigned,certHy that J am the owrer ofthe respective property,oram qualified to represent tIle owrer and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin.Gounty and subject to inspection and approval. <br />!Z~DCA .•;;. <br />Signal!lre of Applicant -Tille <br />~tlCENmIIlSERVlGES\Gl£RlCAl.\PUs.sv.w[(,;,.!AmpS\8jGROACIlW,Eln PERMfl"APPl1c:.'\nOIWOC (021'13) <br />(-5 -::<616' <br />Dale <br />"