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'. <br />-'---~._----_...__. <br />OFFICE USE ONLY <br />JOB #73~()..-(P REF;\!e <br />APN .CR# <br />EXP.DATE ,pn ., <br />VALID.eboll/,t)id ti,to .DRIVEWAYS: <br />STREET Cl <'Wl.f ""*'"Rcl.'* <br />AREA ~f&l~~"" <br />TYPE , <br />FORMS <br />NOTES <br />. <br />4b ~()we.t.j.:kr.e <br />(MaililllJ Mldress) <br />~i:'"c}.::..i:O"...(ij\q~-~O'I <br />(CitY,SMe,lip Coole) <br />poQ)373-Q't32 fx:d2€Pr,(lQ"" <br />(Area Colle -Thlepl10lle IIlllilliJer <br />PLEASE PRlI\!T: <br />Date S -/-..2.016 . <br />To:San Joaquin County <br />'Department of Public Works <br />frY lIS &t 3 \~q b q Lf 0 <br />{Apjllicalll[n~ame) <br />Sketch (Detailed plans may be submitted) <br />. <br />.$ee,5f.:::;e+~~ <br />C l'elV .-to e&{II ..f-:SCo l2 0 q )1~3-71./.2 J \LiB 1P <br />72.Ht>(,t-';~be67Jr-e.-Wotr"f.5tdr1'.5,C-r-etV pfAQ:.f/f"'ef~ <br />-',~f,t R<u'"c...\e£u-ttvtce Ii ';-I.U-4-~wo.rk &{,.U.N"'~tC){(,.\1'e-t' <br />,'Ill,.6'Hk~Ale V'e.\,'U\.bEl-I""\kM'ill.l\.-"U~u,., <br />.The undersigned 'hereby applies for permission to excavate,cqnstruct and/or otherwise encroach on County HighjllaJ(Ri9ht-o~ay on <br />the !.•t7.side of CJ't?M&I'\-t.>...fa.approximately 39 q,O (femImiie _ <br />of l=rb,"z';er-Rff .L ••.•.e(ell ,by performing the foHowingwork (description of work):R..eoplB.e-e,'Dei:.eriar-4;t@4 /ble 11qe'i'6/"PlMentl <br />Work wiJIcommence on or about B-1 0 -/6 for approximately ~days. <br />liE NJ)p.....;.2.3.-lb . <br />I,the undersigned,certij}',thati am 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 qan Joaquin.County and subject to Inspection and approval. <br />~Da~.Signature of Applicant.Title B -)'-:2..0it <br />Dale