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\ <br />OFFICE USE ONLY <br />JOB#100{)5}-t.,.REF II <br />APN CR# <br />EXP.DATE 7tl5"~/l4 <br />DRIVEWAYS:VALID ~IU>0:1:&111.> <br />STREET \:).J IZ-HA(V\f,"~i~., <br />AREA TI2.ACJ:1 QUAD 'W ,~ <br />TYPE P.,Ie.«ef\~-Me"ts ,', <br />FORMS 9SftNWf\lOTES£1:0tJ:::-tM\Cd'\-is-2.o'f <br />IiGiltJ!,Sit<JIDiJ,lilQ)iG!IIlQ1ej <br />Pl~F~JiGC!!iilJiO)~flQ1l((lE~t~iDJ""tG~~Ji]IE~"j"~:IE~JJ~T 2Gl&FEB 2 9 J\;;~Ii:35 <br />b"lEIl.SIEb"RIIU:(X,'T.0:;:liGi.iC WOin':S <br />Date 2..-26 ~2..0'~r:; <br />'to Llo l.iJe5-1-L <\.I'\e... <br />@¥J£)1~fc~-~:21~~[ali'05S) <br />P 6-t IE 1C}'1.3 II Lns-,£S <br />(A}\~I~ff:~[":11'~~~~~jJI <br />To:San Joaquin County <br />.Department of Public Works <br />boq).>73 --"11f3~ <br />(#1m"iG!IIille.ue~elOll1!l>lle IDnnJlIlliJerj <br />Sketch (Detailed plans may be submitted) <br />5ee.--~Ke+~I" <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highw Right-of-Way on <br />the 1\1 side of iii by,,-hgl!4 Fe r-I'~.eel approximately 5"ee He~E~_ <br />of Ka G t -e..l'lcl_---__,tr;to!j:'by performing the following work (escnption of work): <br />a+ <br />Work will commence on or about 3 -/.j -:2.0 /1[for approximately .I ?.C2 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 />eD~ <br />Signature of Applicant.Title .2 -26 -.26 L6 <br />Date