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r <br />." <br />PLEASE PRlMT: <br />Date e --3--2016 -OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />fG /F-..&t 311,'7 6'tIll <br />l/.\p~lil:auilfM~me) <br />t{tI q()vJ e-s+:kl\e <br />IM1li~ii1!iJAdlliiress) <br />~i::b ~-W 1\•<!-A q5>-.20 I.f <br />(CilY;SI~le,Zip Coole) <br />{;:loQ)373-Cfif32 rxd2ee(Je.(0•..., <br />(Ama Gode •IelephoillJ !\lmniJer <br />JOB#73oo53--r.. <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF;!! <br />CR# <br />DRIVEWAYS: <br />Sketch (Detailed plans may be submitted) <br />~ee->ke-+e1A <br />C l'elV .-to C£t II 'of":S C-15 (2 (;)q )1£'3 -7'-/.2/'-iB U.J <br />72..Ht,(.u:.'beAJo r-e_Wor-*=-5-ttt ...rs,C--r-e..-lO f;>fAf<.f/f"eft.~ <br />'l~tU'f\(/\ettr-tH'l.ce II -f-tit"a...~work du.\'~~L{)ct,fe-e- <br />,JIll.btH""~AYo l!'e..I,'V\.be.1'\'~Ml /\.I\.<t,I-~c <br />&-3 -'2..016 <br />Date <br />~Dav~'Signature ofApplicilIJl-Title <br />WorkwiJIcommenceonoreboul ~-':>"2-16 for approximately 2.days. <br />I;;tv D 12..-.2.3 -j b 'I,the undersigned,certify that I am the owner of the respedive properly,or am qualified to represent tile owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />-The undersigned hereby applies for pennission to excavate,construct ~ryd/or otherwise encroach pn County Highway f31f!!It-of-Way on <br />the N side of ;:;D<A..••.h<.l.W\_F~£.!approximately /'/9 fee~F= <br />of }ctlZ+e.r-"eeI '~"by performing the following work (description of work): <br />--''!.1:r-'-{-,A Fl'e 1=D.wh&.Fel'r