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" <br />PLEASE PRINf: <br />Dale ;-7-.z.016 <br />To:San Joaqum.Counw <br />.Department of Public Works <br />fG It=-Rlt 3 I l7 6 q D 5' <br />IApif]licaliln~~me) <br />1~qo vJet.(:4r..e~ <br />(Maiiifllj AiJiiJiress) <br />£.'t t:clc;tc I,,etA q b'::::'0'i <br />(Cill,SI@le,ZUll Coole) <br />bO<:(}37'-Cf.3 rx:d2(;£e,C!e?Iv' <br />(.lima Corrle-ifelejlllolle !\lmniler <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#13°09._""REF# <br />APN CR# <br />EXP.DATE .hhtrw {II,II(,DRIVEWAYS:VALID.~IT <br />STREET q fJI 9r:1 ':===dAREA$h~M."QUAD 55 <br />TYPE aIL 1?tka,nvrt '" <br />FORMS %!wWt . <br />NOTES J <br />. <br />.The undersigned hereb,y applies!,?r permission to excavate,construct and/or othel1lvtse encroach on CounW Highfti!'t..Right'0!:yvay on <br />the __t'J..~__sldeof E "1'tJi 4'\..approximately '-1::2.(:;)(fWAnlle ._~'. <br />of '2 D $*~+o~=tovj ,by performing the fOliowing work (description of work): <br />R.e.p/Ll.Cd3'De-t:erfOb:Cfe.£/bfe .22 <6(l;;'1.t!l M <br />WorkwiJI commence on or about 7'-20'-:2 0 it<forapproxhpately days> <br />lEND f1~;ZO-;ZOI;:'.,I,the undersigned,certify that I am the owner of the respective prcJPerly,or am qualified to represent tile owner and agree to do the <br />work described above in accordance with the rules and regulations of San JoaquinCounw and subject to inspection and approval. <br />WCEMTRAlSERVlCESlCLERlCllLIf'UB-SVWK\MASTERPSIB<eROACHMEl,rpaw.rr APPlICATIOH.Dm;~1131 <br />7-7-02.bt6' <br />D@,e