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OFFICE USE ONLY <br />DRIVEWAYS: <br />_._-~-------_._-- <br />!'.>R't 3111012\ <br />Qt~~Jlf~[!~~'~%m]] <br />To:8@nJoaquin COlll1ly <br />,Department of Public Wo;iis <br />S "~;'cffi'\6:--i;~"i\q;;ctll 9 e.~';~rt1f ~~@lftL <br />(iGiil:.1l,5i.t@,ii:ilJlrc;,,~e) <br />/:<'CJq)<n';f-Cf(Q 32- <br />(~r@.iGOrr!@.r~i~H1oll@ ~Ji!lll1!ller) <br />SI(e!ch(Detailed p!ans mOlY be submitted) <br />lee @l..~~re-hed <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Counly Highway Right-of-Way on <br />the ~side of De./}",'e<.Rei approximately 1.3 ~6 ~jle IV <br />of Cl"r 12'1"12 .LO!D:L ,byperformingthefoilowingwork(descriptionofwork):~e.pIa 1:2.-G'l{1'$"t=l~,.-..+ft,•••..•!""e _ <br />Work willcommence on or about for approximately C1\31>days. <br />1,the undersigned,certify that Iam the owner of the respective property,oram qualified to represent the owner and agree to do the <br />work described above in accordance WIThthe rules and regulations of San Joaquin County and subjectfo inspection and approval. <br />.R.o~ <br />Signature of Applicant.Title