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OFFICE USE ONLY <br />JOB#.7-yJ077 REF#. <br />APN CR#. <br />EXP,DATE [O-I-lb <br />,VALID 8-1-16 TO ID-[-((;DRIVEWAYS: <br />STREET ,/1'10<"-5 h •,AREA 5to:J:io{ll QUAD GO;- <br />TYPE f3,p 1I h(!)Ie * <br />FORMS S'SWW «)JI <br />NOTES-,-,.... <br />PLEASE PRiNT: <br />Date G/ll/f-'-I~(P _ <br />To:San Joaquin County <br />Department of PublicWones <br />CALI t-:'(lQj\Ji A WATEROEIlIJIQ.,E:--"(Applicant Name) <br />!Ioad E,kAFA\i ETrE ST' <br />(Mailing All1dress) <br />-STOC--IL.TON 01 qSC}DS <br />(City,Stata,Zip Code) <br />'d.Dg~Li [0 Lj -?;31 1 ' <br />~(Area Code.'telephone[\lumber) <br />Sketch (Detailed plans may be submiiied),~~J <br />The undersigned hereby applies for permission to excavate,construct andforbthelwise encroach,on County Hi~~ight-o{-Way on <br />the 1\\Q;(::l:b side of 'm ~approximately d ao ~mile _6~iWt__ <br />of 15<;;'''\,'"',by performing the following work (description ofworI(): <br />"10.3(')0>('')'-1t~aoAeJID-:1-.1: <br />Won(will commence on or about "I (p ,lr ajroximatelY days,','(9 I Ifp , <br />I,the undersigned,oertifythat I am the owner of the respective properly,or m aUff,to represent the owner and agree to do the, <br />work described above in accordance with the rules and regulations of SanJoaquin County and subject to inspection and approval. <br />c:0~'()llw -'0 petlo-;b0w C~.ruJL,Signature of Applicant.Title <br />It:affiWSERVlCES\ClERll::Al\PlJil-SV.W/..'\MASTER.!'SIENCROACHMENTPERMIT APPUCA110N.OOC:lOS/13j