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OFFICE USE ONLY <br />JOB#?:>DQ~a..-<'"REF # <br />APN CR# <br />EXP.DATE \2.~ <br />DRIVEWAYS:VALID.B l"2..(I\r TO 2.\\'>h\D <br />STREET 5fcj"'Syl €J;'*. <br />AREA bc•..lv~QUAD f S~• <br />TYPE ~k R-:rl().c~~..d:, <br />FORMS Iww. <br />NOTES <br />To:SanJoaquin County <br />.Department of Public Works <br />fG1{E.fPl'i 31~~87{4~_ <br />IAjpplncalit~ame) <br />tf 1/10 iJJ M.t~U\e <br />(MafiHii1!]Address) <br />.s i:"eIc--to 1'\•e.A C(S;~0 'i <br />(CiI{,51.le,lip Codie) <br />(;?Oq)o3?.:>-et .3 ('>cd::z e e;C!O~ <br />(Area Code.I elepiJoi1e NlID1ber <br />Sketch (Detailed plans may besubmitted) <br />....- <br />.The unde!2igned hereby applies for permission to exc.av.~le,conslrucl and/or olherwise encroach on County High~Righi-ai-Wayan <br />lhe E side 01 £-tei\t~uJ P-.d(.approximalely:Z 70 .~i1e S- <br />ol G «6""'/1,<Rd ~,'k5.se..l+L(JfJ ,by performing lh7 foliowing work (description01 work): <br />/?..eflA.e-e'De-fecIOf'?:Cfe ••..P /,,{e j4.MiJQ -Si:-elt\;uJ <br />cu-€w of €?•/1 fI S::rc,.,1-(e"4'.7:;).bf''>ILJarl"'Ca"1f~';'res."D:qiv.e.leA.M"'''e'','<='Lhk.,kfid Gl"'"te ••."-a/-I? <br />Work wili commence on or abput g'-.2.-(6 lor approximaleiy :;l.days. <br />~ND f2.-S-jtI,lhe undersigned,certity that I am the owner of the respective property,or am qualifiedto represent tile owner and agree 10do the <br />work described above in accordance withthe ruies and regulations 01$an Joaquin County and subject 10inspection and approval. <br />7-20 -~oi6 <br />!Jale <br />Wcem<ALSERIllCESICI.ffiIClIlJPllB-SV.\VK\MAS'JER.PSIEJ./GROACHMS-IT I'ERMIT APPLlCA1]Ofl.OOC:(ll!'1r3)