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.'~-. <br />Dale 7-j,-.2&/6 OFFiCE USE ONLY <br />DRIVEWAYS: <br />REF# <br />CRIt----~~- <br />JOB #7300~~-<c <br />APN <br />EXP.DATE -~-+--~'--14~~~-_VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />To:SanJoaquin County-Depment of PublicWorks <br />PG-~E.PM 51{g <-IY 50 <br />~AIflpbJ1i[li~ama) <br />/jOL!!)4J~>"t '$~t:. <br />(Mailii19 AdliiIJress) <br />!P'ttl ~.k-tt;(1 _,edt -q~::u:,q <br />(Ci[y,Slale;ZUplCoola) <br />-k"qJ 37;;-1'1-3~1J!irea Coile.1falelll10ile I\1lIDliJer) <br />Slmtch (Detailedplans may besubmitted) <br />- <br />-The undersigned hereby appliesfor permissionto excavate,construct and/orotherwiseencroach on CountyHighwa•Ri9ht-of-~on <br />the \..1)side of /\)5"f,~"jet't.f\j _approximately 2.6 eett i1e _ <br />of 0-4 B@ ~LUa-te-eloo '&ct,.fw"Ac'i-lltlj ,byperformingthefollowingwork escriptionofwork): <br />Rerlr.JC',e.Pe-terJ"Dczcted'P"le.22~3 III ->(\~de..I'I.A/ <br />Workwiilcommenceofloraboul 7-18 -2bt6 .forapproximalely 2-days..ErvO il-;w-Mt-6'..i,the undersigned,certify fhat!am fhe owner onlle respectiveproperty,oram qualiftedto representthe ownerand agreeto dothe <br />work described above in accordance wlih the rules and regulationsof san Joaquin-Countyand subject to inspectionand approval. <br />IZ~Qe4&~Sign@tllre of Applicant -Til!e <br />7-.F -:::<61 I' <br />D"te