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PLEASE PRINT: <br />Date OFF1CE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />fG1f3-fl<i 3f;z.U;o83 <br />IAppi1caiiin~.me) <br />t/p~CJ vJe~t~kne <br />(Maiiirng f.\iIiilfess) <br />.!~>tbci.:.:t.o 1\,ci,.A q~.2 ()t{ <br />(Cii1.5i~te,lip Coole) <br />(20Q)3?-"1 rx:d2€€-,co.-\Ii <br />(Ama Coile -IeieplJorne l\l1!il1iJef <br />Sketch (Detailed plans may besubmitted) <br />JOBti 731JO~-~ <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />P,REA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />O'DRiVEWAYS: <br />S Be-$ke-+e1A <br />t I'el{)-to C£t II ..;:rClJ L2oQ)1£""3 -7/.-1.2/e..tB 't'l? <br />/2 t-Lbt.1.-v:.'b8':90 r-e.-WOf'*=-5-t"ci\-f.s,C%etO pfAt<"1 1'efL<.eSf" <br />\lR.!U\l\c,\ettl-tt~'\.C'-e (I Tot-a.~wor-k du.t'i.iA~Lv.t,fer- <br />,M..b tHk.-;.No V'e.-v""be-I"\"hf'{A IV\..<Ci"'tA " <br />.The undersigned hereby applies for permission (0 excavale,,construcl and/or O.lh?JWiseencroach.9n County Highwa~,~t-of-Way ontheIVsideofBu.:ev'l,<L \t.~+qM.approxlmalely /,"f 6 fee~IE <br />of CA-Bft ,,4 ••<CW!.00 ,by performing the following work (descnplion of work): <br />Rep/AI"-€,'De.-fer:/iJf-o:te4 /ble ~22.>6S ba'e.I'\.ClIN'ct'l' <br />Worl(wiJIcommence on oraboul 9-;:>..:t -I ~for approximately 2....-days. <br />IEND t:L~2.3-U,',I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent tile owner and agree to do the <br />work described above Inaccordance with the rules and regulalions of San Joaquin Gounty and subject to inspection and approval. <br />/GAd D~i~'Signotllre ofApplkant.Tille