Laserfiche WebLink
.' <br />PLEASE !PRINT: <br />Date 1-J5-;:z.o [I> <br />To:San Joaquin County <br />.Department of Public Works <br />fG I IS ftlit 3 \V\::?o l~ <br />IAlllllicarii li~ali1e) <br />tf {I ~()vJ M'e ~l\e <br />(Mai~il1gl\iJiliress), <br />~-t"~-tiM .e.f't q5".=2.0I.{ <br />(CilY;SI@le,IillCo!le) <br />(::20'1).3'7,3 -'1If -"32 rx<.J'.2 ePje,c&."l <br />(Are~Code -ifeieiJlilllle I\flllmberj <br />Sketch (Detaiied plans may be submitted) <br />OFFICE USE ONLY <br />JOB#73tJ()5)-(P REF# <br />APN CR# <br />EXP.DATE 11-{I~VALID.e;l((p~~{,I,(P DRIVEWAYS; <br />STREET *\~M.' <br />AREA L.0c\e,V\QUAD -.filE " <br />TYPE f'ole.~().CC~, <br />FORMS s~I!J\!W . <br />NOTES I <br />.The undersigned hereby applies~:::permission t eJicavate,construct and/or oth~rwise encroaoh on .County Highway R!ght-of-Way on <br />the Ai 'sldeof l"6 K.,/..approxlmately.li 2.r feetiJ~1.1.1 <br />of N r=i"e kt/.L iM{e.n ,by performing the following work (descnption of work):&ql4c.-e'De-l:edOr-ccfe4 /hie 2.eo0t,l't Fi"lP,Rei . <br />Work wili commence on or about If -i-i/;for approximately ';Z days. <br />rE ND 1.2.-2 -ItI,the undersigned,certiJi;that 1am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and reguiations of San Joaquin County and subject to inspection and approval. <br />IG~[)a~ <br />'Signature of Applicanlt -Tille <br />mCENJRAlSERII\CE&Cl..ElllClltl.PlJB-SV.WK\.\\ASTffiPSIENCROACHM8<T I'ERWJr AFPLlCATIOH.OOl;{09li3) <br />7-;6-'2..0i6 <br />Dale