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OFFICE USE ONLY <br />JOB#19{){)~J...(p REF#•APN CR# <br />EXP.DATE I~ <br />VALID.~~"....TO :=1WlJ .DRIVEWAYS; <br />;,STREET uHJ ~.,AREA C,rit!e....QUAD Mf. <br />TYPE ~le.~l~~, <br />FORMS 1!Slww .! <br />NOTES I ' <br />PlEASE PRlMT: <br />Date .8~2..l..-.2.0 16 <br />To:San Joaquin County <br />.Department of Public Works <br />fG1f3.&t 31 Cq q dc{0 <br />IAPllliCOllillt\l~m8) <br />t{tI ~()we.st l.A.n.fJ <br />(Mai~ii1gMdress) <br />~1;b clc--to 1\J e-A q5"~()t.f <br />(Cit1,51a18,lip Colle) <br />C20CC)3?-t':j,rx:d2€€..,{!OM <br />(Area C(Jt!lJ •TeielJl10llle IIflli1liJer <br />Sketch (Detailed plans may be submitted) <br />$ee-.~"=e-+eft" <br />t re'V --to C£(II .,r:;C-i5 [2 ()q )15"3 -7L.i.2 /'-lB w <br />72 Ht;(.t.~~be&o re,Woe-ok 5-t:a.r-t.s~C-re\O :?iAl'<,II F"'eft.<.eSf' <br />'l~tU'".C,letU-CH'l.Ce.ll -f-/)r a.-~work.du.I'~~Lvrtd'el' <br />;'VI-btH~~Nt.>V'e-II\'I..bs.""\"'MA Ma..•.~, <br />.The undersigned hereby applieslor permission to excavate,onstruct and/or otherwise encroach on County Hi9~Right-ol-Way on <br />the IE.side of .t..'.approximately 4 7L.(emile .IJ <br />of FE.B.t.-ker-ted ".L.",byperformingthefoliowingwork(descriptionofwork):R.efW--e'De-fecrahde4 /ble £2.~,,7 ""['U1I:to R J <br />WorkwiJicornrnenceonorabolIt $-3p~It lor approximately ~days. <br />lEND '/~/S;--/7 ..I,the undersigned,certify that Iam 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 subjeclto inspection and approval. <br />v'2~Dd~'SJ!ll1iltllre of Applicant.Tille <br />8""':22.-~o16 <br />Date