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DRIVEWAYS: <br />., <br />OFFIGl;USE ONLY <br />JOBl\'13()053-{P REF # <br />['<PI\!-----.'-J---Cfl if <br />8lP.DATE _'?!t4"'._~_ <br />VAiJD AJili..,I.,;;-'TO -fIJ!~__ <br />STREET _l!_1l.Jl!i_lQ.os U _ <br />AREA S1""J;-/:"",QUAD t5t.OT,(PE "fj6re--'-.-'---.-. <br />I FORMS .5&/]&",):Q-z'1 <br />NOTI"B <br />IPmI 50(9..%-1 q~ <br />(~~~[,r,f~@:;'J~'~~i!m.3;.D <br />To:S@nJoaquinCounty <br />.iJepartmell!of PubliG Wmt.f;) <br />~lEASEI'Rli\I1:. <br />Dale 3-23~2CJi6-~----~.---------- <br />5 ¥.t'e-k ,,/',@rYv ,~,~<41i"~lf)1f <br />(!l:iftJ/,S{~e,iliglJCilajJ@) <br />12.~)!j7~-q«£32... <br />(J4reillCilliJle'f@il!iillliliJil@ IlWm!lerj <br />Sketch (Detailed plans may be submitted) <br />See &/:"'+<11.c,hed <br />The undersignedhereby applies for permission to excavate,conslrucl andlorotherwise-encroach on County Highwa Right-of-Way onthe?side of M4-t+11"'d&LC ~approximately.3 ee iie ,e;- <br />of ~B}:11 h T 1&1 .~:~=t~11 ,by performing the following work scriptionof work): <br />J$.oce UIIl"Jeif'-Mati&.et'~C Ad -:tVa <+tee-+c.io.ru.re.2 ~>=to 'he!t,''Pdc <br />Work wiJIcommence on or about .for approximately --.:2.0 days. <br />1,the undersigned,certify that I am the owner ofthe respective property,or am qualified to repf€sentlhe owner andagree to dothe <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />/l..rf)~ <br />Signature ofApplicant.Title $-;:g-~o16 <br />Date