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I',, <br />• <br />---. <br />PlEASE PRINT: <br />Date 3-.2-20!6 <br />To;San Joaquin COunty <br />.Department of Pllblic Works <br />Pb-U=p~,\:s II b~.q71_ <br />(/l!j:;1i;;m;~'{.tHl <br />$t.•.d..-:::1;bVl I e.--A q~;;?o,* <br />(C~'Y,~re,ZipCoole) <br />/z{;C().~?-ql(32. <br />(Area Code.11llspilDOO ~Jllm~l!ij <br />Sketch (Detailed plans may be submitted) <br />tee.a:H"{ehe4 <br />OFFICE USE ONLY <br />JOB#t5M)-(o REF # <br />APN 7bib4z CR#EXP,DATE <br />VAUD .4rf"f +0 'l/Is/i<e DRIVEWAYS: <br />STREET •St!1 .j{'.meJi?;?<?Wi=',AREA "1?()J'Nn,N QUAD /110), <br />TYPE ~k 7pun1e,d • <br />FORlViS <br />NOTES f("yt~ <br />The undersigned hereby applies for permission to excavate,construct antlfor otherwise encroach on County Highw Right-of-Way onthe.s side of»4-I'd M e tl:ta-.B.l..V fl)approximately /e He L'() <br />of II>4 I e.f'a.cL-----,If<.nn"tM ,by performing the following worl<escription of work): <br />Work will commence on or about <br />€)((5:+('Vl~ <br />3-7-2..<?11?.for approximately /~()days. <br />1,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 />wOlk described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />J-o~ <br />Signature of Applicant.Title <br />3 -.2 -.2.0 I 6 <br />Date