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;. <br />PLEASE PRIm; <br />Date OFFICE USE ON~Y <br />To:San Joaquin County <br />-Department of Public Works <br />fGI/3.&t 311B3666 <br />(Apl1licalii Warne) <br />t{fJ ~O vJ e.tt kr.e <br />(l\Ilaiii!!g Ailr(!r~5s) <br />~1;bclc:--to",<!-AC(5'~t>'I <br />(CitY.Stale,lor»Gode) <br />(01)37 -tq,fx'd::z€e.:coM <br />(Ama Code -I eill[fll!olle i\Il111l1iJer <br />Slmtch (DetaHedplans may be submitted) <br />JOB #?3oq5;)"-G" <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />• <br />DRIVEWAYS: <br />• <br />See->t.::a-+e1A <br />C f'e4J 'TO 6~II '~-:rCa (20Q)1~3 -71,./.2/L.iB ott.} <br />72.Htnu-.>b&9ore.-Wor-k ft.tn-(:'s,C-reAD ~L.Vl.tj N?ft.<.eSf' <br />\l~tU'",C,\elU-({v'\.c.e II rbr a-~'work k\"~~'Lvct,fet' <br />1M..b tH~.s.No V'e.I."",be-t'\"hf'il Ma.,l'cA , <br />,The undersigped hereby appliesfor permission to excavate,construct andior otherwise encroach on County Hlgh~'!l Right-of-Way on <br />the !?/kJ side of t"I'fj er tr£!U k;ttfd6t'l approximately q ~i1e It!! <br />of t4\-tI N If'eA e}tL ~d _'L..{}b:j:.,by performing the following work (description of work):R..ep/Ae.e De.prJ(}f?:ge.eP hIe <br />Wori(wili commence on orabou!~-30 -It.for approximately .2.days. <br />/~NJ)j";"15'-/7 .I,the undersigned,certify that!am the owner of the respective property,oram 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 subjectto inspection and approval., <br />R..,A)Dt1~'Signature ofApplicant -TItle <br />B -;2~~2..016 <br />D@ie