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--_...._-_.~._. <br />". <br />APPUCATIOi\!FOR IEMCROACHI\IIENT PlElRl\lliT <br />2U16 JUL 'It AN 10:06 <br />DE"';".::)I'FU3L1C \'IORKS <br />PLEASE PRINT: <br />Dale 7-It -:z.o 16 <br />To:San Joaquin County <br />.Department of Public Works <br />fGIr=.~..31~3 16{O~_ <br />(Applicant~me) <br />tf /)~0 w e.t.t L.A.,l\e <br />(Mailing AlIi/ressr <br />~-tlJ~-to1\,c!J\qi>..:iol{ <br />(Cilj,Slate,Zip Code) <br />(20Q)3?3-Cflf32 r>aJ::z@pQe.,C!6'M <br />(Area Code.Telephone Number)' <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#13(J()9.-4-REF# <br />APN <br />"~'"CR'EXP.DATE <br />VALID.DRIVEWAYS: <br />STREET 7/i;})j£,d:0 Pi {t,bv • <br />AREA 1tt.'.QUAD IIIw • <br />TYPE •~fy!ucm.r.;:fFORMSsslw...] <br />NOTES I <br />I <br />"The undersigned hereb.yapplies for pennisslodh~~~con~ndlor oth~l1Niseencroach on County Highw~y ~t-of,Way on <br />the.$side of 1(1 WtJa .e.approximately 2".'>,8 feetl~W <br />of.-£,~,.".'L 0'4':;(.,by perfonningthefollowing work(desc~tion of work):.'Refl4.e.e.ee'tec,f?t4te.-P hie -/%q/20 til w~bru!1(j}"&( <br />Work will commence on or about 7 -';).6 -L6 for approximately .2.days. <br />~tVD 11-::>.{)-i6 ' <br />I,the undersigned,certify that 1am the owner of the respective property,oram qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of san Joaquin.County and subject to inspection and approval. <br />vG.J4.-.-l Da~'Signature of Applicant.Title <br />'7 -)/-1--2..016 <br />Date <br />•