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OFFICE USE ONLY <br />JOB #1~J..(P REF#.. <br />APN CR# <br />EXP.DATE J2~/7 <br />DRIVEWAYS:VALID.~j ~"'17'•STREET..fie.RJ . <br />AREA ~QUAD lJiIJ • <br />TYPE • <br />FORMS ':£>'wR<il1u-~ <br />NOTES <br />" <br />APPIJCATION HlR IE!\iCROACI-lMIENI PlERWU <br />PLEASE PRll\lf: <br />Date 8-;43 -..2.016 <br />To:San Joaquin County <br />.Department of PubliGWorks <br />fGI!S ~3ll f3 3$3.2... <br />.(Apjjlicalit If~~me) <br />tf,dtJ wet+:kl\e <br />(Maiffiri!l Adilress) <br />~1;"eIc--to",M qs-.:::?()I{ <br />(Cit1,State,lip Corne) <br />{;201}373-Cf£f32 f'x:d2€Pre,COM <br />(.lima Code ..H elephol1e WI!iI1!ler <br />Slmtch (Detailed plans may be submitted) <br />S ee,.-5b+~~ <br />C f'el<)-ro 6t{1/.fr7SC-o [20 q )1£"3-71./.21 LiB tv <br />(2 Ht>[.t.\~be67ne~Wo,..Jc 5""t~r-f.s.C-r-etD pit.£(.)/I"efi.{esf' <br />'tRd"I'".c.letll~CtlAceII of-bt-6t-~work du.l'~~l~..?rt,f€-t' <br />1M-b 'H "'-~IV C V'e..IM,b e-t"t It-,j'tl p'\Jl.a.,1"~, <br />.The undersigned hereby applies for pennission to excavate,construct and/or othernise encroach on Cou ty Highwa Right-of-Way on <br />the IAI side of De-v,tlik5.R(l .approximately!J.e ile_~(IV~ <br />of "I lA,"''''''111,-+li V\ed .L (j ()'I.•by performing the following work (escription of work):ge.fl«t'-e,'Dei:ecrah?;te."R fJ/)/e 19;1£/l7~'])L$Vt.'e!:. <br />Workwillcommenceonoraboul g-M-l6'for approximately =:t days. <br />f;END!-30-(7 'J.the undersigned,certify that Iam the owner of the respective property,or am qualifiad to represent the ownerand 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 Applic@nt.Title <br />fl-::23 -2.016 <br />D@te