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OFFICE USE ONLY <br />JOB#'130(6J.-f..REF#•APN CR# <br />EXP.DATE 2-/;/'7VAliD.~'I..o '10 p.MI7 DRIVEWAYS: <br />STREET f:(){/I'lt. <br />AREA '1fIC.'(QUAD ?W , <br />TYPE &1t~1a«AJe"i;* <br />FORMS $¥'wM :NOTES <br />PLEASE PRINT: <br />Date $-::2.5 -2016 _ <br />To:San Joaquin County <br />.Department of Public Works <br />fG/~&t 3lV1S~&fo <br />(Applicalil ft~ame) <br />t/tI 1{)vJ e.t -t !...A..fle <br />(Mailill!!Milmss) <br />.s,'icc.}.::...i:b ",c!J\q.£".=!()'I <br />(CitY,Stale,lip CIl~e) <br />bO~37 -,rKd2e <br />(Ama Code.I elelll10lllJ !\ll!lilloer <br />Sketch (Detailed plans may be submitted)37,7716 V <br />_1.::::l.I I 33 LJ ;;-7 <br />ere\().-to 6t{1I.,f-:f66 [20Q)1;-3 -71.1.2/'-iB w <br />72 t-Lt>c.n-.>b~re.-wocr-.Jc 5-t-4 r--r.51 C-r-elO j>lA",f/F"ef'-{eSf' <br />~J ~~'ti'-til'".c.\ecu-tH'\ce II rtJr ~VUi.wor-k aM.I'H"~LofiAfel'. <br />1M.6 eHk.f..No V'e..I.'V\-bBt'\"hf'lJ M&..,I"u",• <br />.The undersigned hereby applies for pellDission to excavate,construcl andJorotherwise encroach on County Highway Right-of-Way on <br />the S side of c..s,d tlr A-v-e'.approximately .3 l.F ee ile~#~_ <br />of £!.tlVI a I,Bill c>'Tv-"a.ij...by perfonming the following work escription of work):R.e=f!A.ece De-f:ertot>::;t;feeR 8>Ie <br />Work will commence on Dr about Ed -3"-Ib for approximately ::z-days. <br />I;END 1"";30-/7 .i,the undersigned,certHY that I am the owner of the respective property,or am qualified to represent lile 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 />K~Dd~'SJ9namre of Applicant.Tille /3-:23 -<'0\6 <br />Dale