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OFFICE USE ONLY <br />JOB I!73/)o~-(p REF/!• <br />APN .CR# <br />EXP.DATE t.&DRIVEWAYS:VALID._2j}Y.DTO '/I",U7 <br />""STREET ~C. <br />AREA 1(tl";QUAD NG * <br />TYPE * <br />FORMS <br />~{~1'l'l.Id <br />NOTES <br />~JjN)!./..i <br />To:San Joaquin County <br />.Department of Public Works <br />prJ "(3.&i 3 \\q q ~&? <br />lJ.\pplicarilll~ell1e) <br />PLEASE PRlMT: <br />Date 0'-.2.2.-2.0 I 6 <br />4;y ~O vJe-sf:kne <br />(llllai~il1!lAIIrdwe5s) <br />~t(.Jer-.W",<!-A q5.2ol{ <br />(Cil1.Siale,lip Colle) <br />pO~373-q~32 r~2€fFe,~M.(Area Code -Ieiepholle I\JlIDlber <br />Sketch (Detailed plans may be submitted) <br />j ee..-~f<:e.+JA <br />tl'elV -to c-etll.';-SC{j L2oQ)1£"3 -7'-1.2/I-/B tv <br />/2.HtJ (.U::t bB?:90 re.,Woe-i::.5-td r1'>J C-1e.ID j>fAA Ij F"'efi..!eSf' <br />\tRtU\",c.\~N{V\.ce II "f-br a-VUi..l/J6r-k d-u.-\"'0,..~LtHt\fe-l' <br />1M.-"tH~.s.tV ()V"e-vv..,bB-t'\"hM<M4-,1""~, <br />.The undersigned hereby applies for permission ~excav~onstrucl andfor otherwise encroach on County Highw9J(Right-ol-Way on <br />the 6 side of E <!n tI ,et~.t<..approximately 1'2-.f€elAnile E; <br />of N q~Fr-o",-t 4~'I+~fo ,byperformingthelollo~ingwork(descripllonolwork):R..e~De-t.ecrnticte.eP /b Ie 'ill 't8 E-Ce III Cd' <br />Work will commence on or aboul f'-;.{-l6 for approximately :2 days. <br />IE ND j ~IS -l""'..I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent lIle owner and agree to do the <br />work describad above in accordance with the rules and regulations 01San Joaquin.County and subjectlo inspection and approval. <br />~Da~'Signature ofApplicant -TItle <br />$~:;l~-'2..0 i6 <br />[laie