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OFFICE USE ONLY <br />JOB#1Joo5;;~Ca REF#• <br />APN CR# <br />EXP.DATE ~11 <br />DRIVEWAYS:VALID.830 I~10 ~ll' <br />STREET H W('l"l f/l6JJrf!b~ree.* <br />AREA ~4k~~~W • <br />TYPE • <br />FORMS $SJij . <br />NOTES <br />PLEASE PRINT: <br />Date f{-;2.3-.zo II, <br />To:San Joaquin County <br />.Department of Public Works <br />fG "f3.&t:3 It "7 b q,J BlApplicant~.me) <br />tf (I qo vJ e.5t L..t-I\e <br />(IVIaim!DQ Adlilress) <br />s:-t bcl<=-.ti;?I\.e.A qG"~Ot{ <br />lCil{,Siale,ZopColle) <br />(;20Q)3?3-Qif32 fxd2€f{Je,coM <br />(Area Coile -Thlellho!Dl!IIllJJillbeir <br />Sketch (Detailed plans may be submitted) <br />S ee.-'>fce.+f-,~ <br />CI'e"-l -to c.t{II ..f-:S CtJ [2 (/q )1~3 -71.'1.2/!-fB w <br />12 t-LbLU-.>be6h~Wo,.f.5t"dt'-r.s~e-r-etD ~fA~11 NU(~ <br />\IRtLl'"c.\elll-CH'\C-e II -f-t't-a..~c.Uor-K k\'~~Lv,t..fet' <br />,M-6'1-tk.!i-Mo V"e-IM.bs.t'\"hMi Ma.,l"v..,, <br />.The undersigned hereby applies for permission to excavate,construct and/or othenNise encroach on County Highway Right-of-Way on <br />the Il )side of .5 q g E-r-6 1Il"t<l~~approximately I :<22 q @/mile..5 <br />of P r~eA..C-a ,1M y>gd ,Md.rdl''t~y perfonning the following work (description of work):l?-eflA.e.e'De-i:.ecrnhde,.R /bfe 11e 1.19 ~qq ET& <br />Work will commence on or about 9 -:3t2 -LG for approximately:2 days. <br />~tvI>I~3b-t7 .I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the 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 />~Dd~•Signature of Applicant -Title <br />,