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OFFICEUSEONLY <br />JOBti 13(X)~0--4>REFti •APN CRit <br />ExP.DATE~~DRIVEWAYS;VALID.?:p :0 iIn <br />f;STREET 3?tI 'ilO~. <br />AREA ]J&¥~~• <br />TYPE • <br />FORMS <br />NOTES <br />PLEASE PRlI\IT: <br />Date ~-.25-.2.016 <br />To:San Joaquin Cdunty <br />.Department of Public Works <br />fG It=.p~3 l,l B .3 q 37 <br />IAppiicalit n~ame) <br />t{tI ~0 vJ e.st l..A.f\e <br />(Mau~ii1!lAiliilress) <br />~'i:l1 e}c..-to 1\,<!J\qS.2 ()tf <br />(cit1/,Stille,Zop Glloe) <br />(20<l)3?3-Cflf32 rxd2e~,COM <br />(Area Code -IeleplJolHl!l\looniJe <br />Sketch (Detailed plans may be submitted) <br />$ee.->fc:e.+ek <br />C l'eIV -to C-t{1/.FJ:C.6 (20 q )1~.3-71.-/.2/LiB tv <br />/2..t-Lt>(.u-.:.'be6!ore Work 5-ttir-t'.5~C"r-etD pfM.1J 1"eft.<..e.Sf' <br />'lRtU'",c.-\ecu~CtIAc..e 11 Tt';t'a.-~work dul'~Loftrfet' <br />,IVL bt1-/;k~tVo V"e.\M,bs-I""\kr-u M.a.,f"~, <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroacl};m County Highwey Right-of-Way ontheU)side of S,0'\:r"5 e.~d .approximately 6 .3 @B)mile.s: <br />of 8e-J:.,hrb.!I\~.td ~.,~e:tkaPl.-'(.by performing the foliowing work (description of work):ReflA.e-e De-teclt2r-.:ge.e.R hie <br />Work will eommence on oraboul B-50 -16 for approximately 4.days. <br />fiENi)1-30 -i7I,the undersigned,certiJY 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 in accordance with the rules and regulations of San Joaquin.County and subjeclto inspection and approval. <br />~D<1~.Signature of Applicant -Tille