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PLEASE PRINT: <br />Date OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />fG It=.&t g.i I.B 3£6tj- <br />IApplicalil~ame) <br />4tl1()We.tf L..A-ne <br />(M<JiiirillAddress) <br />!-'t i1 clc--to 1\,c1A qs;-~0 l{ <br />(CitY,Srnle,lip Code) <br />boV373-q~3<rxd2e~e,~M <br />(Area Code.1elejJhoile I\II1mDe <br />JOB #13:v5J~bAPN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF;!!• <br />CR# <br />DRIVEWAYS; <br />w(IJt1~1I. <br />Sketch (Detailed plans may be submitted) <br />S ee-.>/-c;e.+~~ <br />CrelV -to 6~/[..f:r Co l2 0 q )1.s3 -71./:21 '-lB tr;> <br />72 Ht>e.t.r-->beA7Jre..-Work 5-tdr--t.s~C-r-eto :;.iIut.l1 I"eff~ <br />'t~tl..l'f\c.leeU-(H'\.c..e 1I rOr ~~.work k\';"...~l.{)(t,fel' <br />1M-6 eHkJ'.No V"e..vv..be_I'\"hf'tl M<'t-,reA p <br />.The undersigned hereby applies for permissIon to excavate,construct and/or omelWise encroach on County Highway Right-of-Way on <br />the NIE -effie of ~hlec J)-evri'e£..approximately.feet/mile _ <br />of ••.."«.eo <-o/)':L.,by performing the followIng work (description of work):"'-t ".I <br />Work wiIJcommence on or aboul -~(-for approximately .:a.days, <br />IE tVi)1-..36 -{7 ,I,the undersigned,certiJi{that I am the owner of the respective property,oram qualified to represent the owner and agree to do tha <br />work described above in accordance with the rules and regulations of $an Joaquin.County and subjectto inspection and approva1. <br />v2~[)a~'Si!lnature ofApp!icant.Tille e-.2~-<.016 <br />Dale