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PLEASE PRINT: <br />Date @.-7 ~. '.10 \'6 <br />To: San Joa,quin County <br />Department of Public Works <br />CA LI r~c"i/2J01 A \N ATE/2..0ErlD )Q,E <br />. (App!ieon! Name) <br />/Goa E kAFA'-f ETf"E ST <br />"'SToC,!t~TbN ell qSc\D5 <br />(Ci!y, Staie, Zip Code) <br />(dD9~ Lf Lo L/ -~311 . <br />Sketch (Detailed plans may be submitted) <br />JOB# <br />APN <br />EXP.DATE <br />· VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />-. <br />OFFICE USE ONLY <br />13tJ071 REF# <br />CR# <br />. 7. ·. /~,r!Ja e,f; 1,je,rd 10/2,/20 DRIVEWAYS: <br />O I I I * GtM~ A,4!;. . <br />'2 T,;t:,/1:.T<,N QUAD cc, * <br />~t(,,f{OU, . . * <br />~j,t~, · ?20fd? M rf;l1it ,, ,1,,d,../2"'1$ ,, . . <br />--. . . ---·--. <br />The undersigned hereby applies for permission to excavate, construct and/or otl101wise encroach on County High· 1 Righ~£f.Way on <br />the J\l,,r th · side of E.lrow<.»! Ave, approximately ::l O fee mile OS± <br />of ~f'.v.lO..CL "QvL • ·., · by performing the following work ( scnptlon of worfc): <br />761000 <br />Wort( will commence on orabout _ __,B:J._· -'''-~-'~ ... o"'-1._.8,,,_ ____ ~forapproximately __ ~f;..,O..,__ __ ~days. <br />I, the undersigned, certify that I am the owner of !he respective property, or am qualified lo represent !he owner and agree lo do the· <br />work descrtbed aflove in accordance with the _mies and regulations of San Joaquin Gouniy and subject to inspection and approval. <br />,1J:\CENTRA[BERVlCES\Cl..811C/ll.\PtlB:-SV.Wf..'IIM61ER.P31ENCROACllMEHTPERMIT Ju>p/JCAllOilDOCl [D9/13)