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OFFICE USE ONLY <br />JOB#13tJ05J,-<"REF;!!•APN CR# <br />EXP.DATE ~1,1If <br />VALID.~~to ;NI7 DRIVEWAYS: <br />STREET ~•.'" <br />AREA ~.QUAD Nt:.• <br />TYPE ~kAeI~ML..q.• <br />FORMS yww t <br />NOTES .' <br />. <br />, <br />To:San Joaquin County <br />.Department of Public Works <br />PLEASE PRINT: <br />Dale 13-23-.2.016 <br />fGI{3.&t2f~13D~b <br />(Applicalil Wame) <br />If (dO vJ e.tt ~ne <br />(l\IIaiiii1lg Adilllress) <br />.s 'tt er-..-t€M .c!J\qS.2b t.j <br />(Citf,Slate,lip Cllde) <br />POC()37,3-<qi(-32 rxd2€!.p(1e,eo"" <br />(.Area Code.I eiepholi8 l\l1m11Jer <br />SI<elch (Detailed plans may be submitted) <br />.5ee-.>f.:::e,+e1A <br />t l'el(}--to C-t{1/..f -:r ClJ l2 0 q )1£"3 -71,'12 J LiB w <br />/2..t-Lb(.U~be6!o re.-Wor--k.5-t-tlr-t.5~e.-r-etO ~fM.,1J I"ef~ <br />.lRtU'"c"IeA.r-av\.ce II TOr ~VUi-workdu-t-;""'~1..V(~fe-f'. <br />1M-b~'1;""~No V'e..I,,,,,,be,.f'"T hf'tt M-a.,•.~p <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach ~n County Highw Right-of-Way on <br />the _~£~__side of La 6 ke-.RA.approximately 6 3;eet!He LV <br />of eA-B 8 ,L Qc.'-k:.e.-fo wi ,by perforrningthe following work escription of work):I?-e.pl«e-e.'De.i:ecrnl);:ded (Me 12.'&6 L"ei-ce <br />Wor!<will commence on or about 41-30 -16 for approximately :z days, <br />~ND 1";"..3b~l7 ..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 subjectto inspection and approval. <br />~Da~-Signature of Applicant.Tille <br />...