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OFFICEUSE ONLY <br />JOB #'13~So.-c.e REFit <br />APN CRII <br />EXP.DATE \\~VALID,7 (,e.\I<C 'TO jh\\o DRIVEWAYS: <br />STREET BfLle.lta.((d,"" <br />AREA W"'f QUAD AlE * <br />TYPE *\e~\~~FORMS %(wwNOTES <br />2.&/6 <br />To:San Joaquin County <br />-Department of Public Worke <br />'1oLla t{)'~s"t k~e <br />(!1/I1Jiiii1!lI-\«ifrdlrees) <br />-5>1:~~1G-tlj'f!'l d'iPi qf;:u>4f'(City,St1nte;lull ColiJe) <br />&l?qJ 3?~-'i¥-~.2..iAma elide -1eleJillJoITIe!\lln~er) <br />Slcetch(Detailed plans may besubmitted) <br />-The undersigned hereby applies foi permission to excavate,construct and/or oth~rwise encroach on Counly High.l!'atR!ght-of-Way ontheWsideofNBFIk--e-lia.-Rd _apprOXImately I 7 :2 ~J!e..$ <br />of L u he!.L '1 •V t~T{I)t •by performing the following work(descripTIonof work):,, <br />Re efta te.Pe+,e f'l't:>(/1;t'ed .p;,iF.'2.2 0 '2l IV Sr-ueJ fa..1M1 <br />Worlcwill commence on oraboul 7 -If)-2b t 6 -for approxima/ely .z days.ErJO /1-:;W-2bl-t .,I.the undersigned,certiijr /hatl am the owner of/he respective property,oram qualified to represent the owner and agree /0 do the <br />work described above in accordance with the rules and regula/ions of San Joaquin-County and subject to inspecTIonand approval. <br />&~Dc:;,.;;'SiglJawre of Applicallt-Tiile 7-5'-p';(o!/' <br />Date <br />fIIII