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1 <br />fIl'llEASIE fIl'R~IU; <br />Dale jJ~7 -.20i6 <br />To:SanJoaquinCounty <br />.Department of Public Works <br />P;'''1311702.3\«~~~tf!.~r.I,::t~~ff1m~}I <br />5 t@b\\c i'?(;'j f e.:lJo cl'G"";e«Ju,~ <br />(tiRy,S[~t@,Zir G!!~@) <br />(2.£>9,).;n~-qq32. <br />(UlwooiCilJiil~.•i@ieIffiJl1ijillll1li!mffJ~1j <br />Sketch(Delailed plans may be submitled) <br />See a:t:4-"l dl'liUJ <br />OFFiCE USE ONLY <br />JOB#'1)00':;"2..-(p REF;\! <br />f-IPl\I CR# <br />EXP.DATE _.~(!jJ I~ <br />DRIVEWAYS:v.I\L~_-atl,,~TO -1.~iliL_ <br />STfkE!_i),f,-f.>1~'.."AREA £apj_.__QUAD _M ~~-jTYPEfM~b"""",i:1.: <br />FORMS ~(IA»~) <br />NOTES <br />, <br />. <br />. <br />,.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Counly Hig!1rY Right--of-Wayon <br />the £5.side of J1L I14<>rfl-tO£\Ad approximateiy 2.1i7CJ ~miIe.£ <br />of 1M LUaOJ t,r f'd~e::fld ,j..O DI .by performing the following work (description of work):.~epItJlCe..e:'il f.tt'~~fb_.-'_e ._ <br />Work will commenoo on or about 3 -itS -2.C?l6 forapproximalefy""G 7-1-.:w/!?days. <br />J,the undersigned,certify lhat I am the owner of the respective properly,or am qualilled to represenl the owner and agree to do the <br />work described above in accordance with the mles and regulalions of San Joaquin County and subjecl to inspeclion and approval. <br />J<o~ <br />Signature of Applicant ..Title 3~7-2.016 <br />Date