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,-" <br />PLEASE I'Ril\llf: <br />Date J ~7 ~2rC>i6 <br />To:S@nJoaquin County <br />.Depar1meITl[of Public Worli" <br />!?6 t,S;ff"i\~\I 6~:2,3 \--.:.~-_.~_._-~~~-~--~----«~~Jf[.~~~~~{£im-?} <br />5 "~G'(d--k;;!',fJ#'ll !!e~~t;j;;-~(b)Yl <br />(lC:iil)y,SitffiJlt@,ili~G@1iJe) <br />12.il>q,).:n 2J:-q«f 3d.. <br />(Il.m~C\lIiiJe -lf~I!!JIlIlIJiJlITlIil~Ji!nJJ!l~H) <br />Sketch(Detailedplans may be submitted) <br />See ~'H-@jdneel <br />OFFICE liSE ONLY <br />JOB#73005(}-(P REF #APN CRt'EXP.DATE _.dtHo . <br />VALID _&511(,0 ~TO ....edJH_o __DRIVEWAYS: <br />STREET JJ1~.&JJl1JLPr...e <br />AREA .1f..t!,'~.QUAD -SiD ~_..,---- <br />TYPE P~ie 'f'lKGl'YIg.d <br />FORMS 5..;uvv.J ~-lNOTES <br />The undersignedhereby applies for permission to excavate,construct and/or otherwise encroach on County Highway_~t-{)f-Way on <br />the IAJ sidebf ~Ma .•.Arf/Aul',j),..approximetely /,'i fee~.£ <br />of IAI L ,''''Me Rtf .,Tr:4 ~~.by performing the following work (description of work): <br />.~e.pltll ••.e_'=:"I~-tt'~c-+RJ.•......I.•.e _ <br />Work wiIIcommence on or about~3~-~/5"~-~2~6 •..•.•'~..-f.01'approximately E/II b 7-t -;;ac 1£days. <br />1,the undersigned,certify that I am the owner of the respective property,or am qualifiedto represent the owner and agree to do the <br />work described above in accordance with the rulesand regulations of San Joaquin County and subject to inspection and approval.. <br />(f..o~ <br />Signature of Applicant.Title <br />\ <br />3-.7-.::aoI6 <br />Dale