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" <br />PLEASE PRiMif: <br />Date 7~J$2-zoI6 <br />To:San Joaquin County <br />.Department of Public Works <br />fG/f3-ftll 3 n,Q5 7 {O <br />IAfJplicaiil n~ali1eJ , <br />,,{/~()W e,5.f:'l..A..l\e <br />(Mamrtllj Aililress) <br />,!~:-tt>'*-"t~1\,e,A qS;~Oi.( <br />(CilY,Sl~te,Zip Colle) <br />(?oV3'7 -'1'.3 fx'd::z€,e,C!O~ <br />(Ama Coda ..ifeiellilofle I\1lI1mber <br />SI<etch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#13M5(}'-(p REF# <br />APN <br />tzlLlik=~#EXP.DATE <br />VALID.8N'iA TO Jilib~DRIVEWAYS: <br />STREET vi/!tI+o,",Rd.;, <br />AREA '-••:.de '"QUAD l\!E.., <br />.TYPE P't-e.:.~lo.c.e.~, <br />FORMS ~""vJ . <br />NOTES <br />7-)8 '-~Oi6 <br />Dale <br />Dti <br />Signalure of Applicant ..Tille <br />lSER\IlCES\Gl.ERlCAL1.CUBSV.WK~'WISlEfU'SU::UCROAC:Il/I.Elrrf'ERMJr N'f'LICAlJOfl.OOC;(OE1t3) <br />Work will commence on or about fJ -i-I Z for approximately .2 days. <br />IE Nj)..I;).-2-"',the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />ark described above in accordance with the rules and regulations of San JoaquinCounly and subjectto inspection and approval. <br />The undersigned hereby applies for permission to excavate,onstruct and/or otherwise encroach on County Highwfl,Y-Eight-of-Way onS'side of M ~I R.approximately q$£'@'e}MJile I:::: <br />Nt-)'P\of'.&(,L i ~t:J .,,by performing the following work (description of work):l?.e-fIAe-e,'De:.-terfor-4:feJ!/ble 2:2 0/5;'E Pl1/f"'f6t1