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~lEASIE ~RI\\I1f: <br />Date :z.-AI.(<2.b l6 <br />To:San Joaquin County <br />.Department of Public Works <br />_We f/""3/o6QQ3lf(d1~,~,~f:.~~:'NLi~~m~J) <br />.Ll"'d..a yJ e~'t LAVte. <br />J100[j~~~~~i!ilfi)Ir;':,~J,]ss)~~. <br />Gtd t-kef':11\cA q£~"4liCu~,sJ,~I/J,ZitplGOalla) <br />{Z6t~)373-1'157- <br />ll-lr«!@iC«lii1e.ifa~etplR1ofi1e~lIImller) <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB;\!1300'9 ..(.;,.REF;\! <br />APN CR;\! <br />EXP.DATE 765«(,.. <br />VALID '3(lA(p '0 ikff'fa DRIVEWAYS: <br />STREET WbI$121).., <br />AREA fb!C!t QUAD 5w ., <br />TYPE P;j&/.:;umeaf ,~ <br />fORMS <br />NOTES <br />The undersigned hereby applies for pe ission to excav te,construct and/or otherwiseencroacli on County Highway Right-of-Way on <br />the IAI side of approximately AliA-feet/mile IIIO! <br />of 8e:rv.JE'd"d'e ed:M~AilA.~f'e.-In.at ,byperforrning thefoilowing work (descrtption of work): <br />.._.__"""ti~~~A:~~~f~t!~A~----- <br />/l,-efIACA>ak~()J ~/Je l/TtzteJ&~B~",~fIj)~_----- <br />Work will commence on or about ;,-2_----'1~6~for approximately 12.0 days. <br />I,the undersigned,certify that I am 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 County and subject to inspection and approval. <br />QD~ <br />Signature of Applicant.Tille