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- - -T `' - t <br /> PLEASE <br /> 7 t�T AP I--C��1'.�O FOR Eta�..ROACHttN 1 P��.�' UT <br /> ]] OFFICE USE ONLY <br /> Date L2 ZI _S— JOB It REFN <br /> APN ?- _ - M'0 - D 1 CRv9 z <br /> To: San Joaquin County DePartmemt. E.P. DATE <br /> Vr1LID b i TO / DRIVEWAYS: <br /> STRE ET Ceu <br /> (Applicant Mame) AREA c h QUAD •GG .- <br /> TYPE S t sem, tic <br /> 1-33 Gv, ZV4714 4 7Z sr FORNss <br /> (14ti-iiliin.g Address) NOTE <br /> 5'k--e lvp C,-f 9�2,03 <br /> (City, Suite Zip Code) <br /> (Arca Code -Telephone Number) RECEIVED <br /> OCT as f995 <br /> Sketch(Dei::lei plms may br subrrit::cl) ENYiRONMEN7AL HEATH <br /> CA <br /> The undeniped hereby applies for permission to excavate, construct and I or otherwise encroach on County <br /> Eifahway:Right-of-Way on the Al A-S side of Coa KKfCIL . Uy+yc + Lt).s i§e 1!d►ssIt_ _ approximately <br /> lett 1 mile of , by performing l <br /> following-work: (description of work): '50 loovl V'ICA 5 u ec-12 V-J -Lo- «, w f/- . /4,%n <br /> J� f�� S � Irs ren s �o rou�c sol,�dl u. c�rN.v�r • �rd��f< <br /> Work m•il.l commence on or about 067W43 152 2-0 for approximately��days. <br /> I the undersigned certify that I am the owner of the,resp`c.6ve property, or ant quayf ed to represent the owner <br /> agree to do the tivork iJcscrlbed above in accvriSanw.with the rules, regulations of S:ua Joaquin County and subj <br /> to inspccil and approval. <br /> z 7 1 f 9s- <br /> S 1�ATU rRE OF APPLIC.4jNT - =E DATE- <br />