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" <br />PLEASE PRli\If: <br />Dale 8-.$-2016 OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />fG/f3.P#t 3 I~I 7Qo3 <br />(Apillicaril !\lame) <br />tftI ~O vJ est kn.e <br />(Mau~m!JAIlldress) <br />~tocic-w/\,CY\q£"~()I./ <br />(CitY.Stille,lop ClJlle) <br />bD~373-q~32 rxd2e~e,~M <br />(Area Code.1felephlJlJe lIlllmbe <br />SI<elch(Delailed plans may be submitted) <br />JOB#1~o9.'<O <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />• <br />DRiVEWAYS: <br />~ee.>ke-+ek <br />C l'elV -to C-tt 1/..f".TCa (20 q )1£"3 -71,,1.':2 J e-tB 'IV <br />72 t-Lt>('t.r>be&ore.-Wor*=-5-t"dr-rS,c.r-eto plM..IJ F"eft.<..e.Sf' <br />'lRItA'.\.c.\etlr-CH'\.ce.iI ';-/)1-«t.,~work k\""~~t{:ut,fet' <br />I'VL b t1-l;k~A.J{j V"e.IM.be-t'\'kMA tAl\.-<1.,1"'~.p <br />.T,he undersigned hereb.yapplies for permission to excavate,construct and/or oth?llNise encroach on County H19~R!ght-of-Way on <br />the U I SIdeof ~<M'\A U -e~"~i/J...'.approximately t t'g 0 emile'>of 0a k!AI filO"£>ReL ,__k.-Ir>"'--.,by performing the foHow/ngworl<(description of work): <br />ge.pI4.e:-e'.De.-ferinD:deJ 1h1e65qG .tid!!,Allell <br />Work will commence on or about ;?-30 -[6 for approximately .::z.days, <br />lEND 1~.so-'7 .I,the undersigned,certiJi{that Iam the owner ofthe respective property,oram qualified to represent the owner and agree to do the <br />work described above in accordance with the ruies and regulations of san Joaquin County and subjectto inspection and approval.