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\ <br />Ii'llEASIE Ii'RU\!If: <br />Date iJ <t3-2C>16 <br />To:S@uJoaquin COUl1ty <br />.Department of Public WOfts <br />R\~""""tru__~I"b-~:?rl'f\.3 IIq q 6 ';7-3 . <br />~t~~J/e.~.0:~r0fJffi.3p <br />S \"5d~,,>'Pc'!I t:-i~~(G'"~@t,I~ <br />(iC-iiijr,S!bFJ!<l,ZilJ]iCilll1il) <br />(2.~)~f~<l.!i,..,,3=2.~_~_~_(IIrnm iC«liiile•11\8iiillJllIJlllil@Ninmlil:eF) <br />Sketch{Detailed piailS may be submitted) <br />~ee~++q,ehed <br />OFFICE USE ONLY <br />JOB #7~J.-(P REF # <br />API\!••CR# <br />EXP.DATE qt.,biP <br />VAUD ~To ~1~,'_ <br />STREET tfl~~~--,=---",--__.. <br />"'REA :)10£.'4 QUAD .21.0_._,_, <br />TYPE .pole.R~~_ <br />FORMS ~._W=",_ <br />NOTES <br />DRIVEWAYS: <br />.•~,',--- <br />l <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Counly Highway Righ!-cl-Way on <br />the W side of ,/If Vbn"V.1dvl 41 approximately 3sS0 ~ile $" <br />of vJ ~I)"!IIe,&d ..'Yr-a4V 'by performing the following work (dsscription of work): <br />---'-\------------'--==~------------------ <br />Work will Gommence on or about ;::::'fV-P <br />forapproximateiy q-l-~6 tl .days. <br />I,the undersigned,certify that lam 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 Counly and subject to inspection and approval. <br />I-o~Signature of Applicant.Title .5~'2.:3 -.:to f 6 <br />Date