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,.. <br />I'lEASE I'Ri~f: <br />Date 3-1-2016 OFFICE USE ONLY <br />DRIVEWAYS: <br />:~j <br />REF II <br />CR# <br />AREf.:\ <br />TYPE <br />FORMS <br />NOTES <br />To:Sen Joaquin County <br />.Department of Public Works <br />G-t 17':'\'<;:+0111 .el\-190'1 <br />(tifi:y,S[ete~li[PJ CilJiQ19) <br />(PDq)37~-qtf.~.2.. <br />(#\W9@ Corne •fe~I![PJl1i1Jlle U\l~ii1i1lef) <br />Sketch (Detailed plans may be submitted) <br />,S-e:e.5{<:e+c~ <br />. <br />The undersigned hereby applies for permission to exc"construct and/or otherwise encroach on County Highw Right-of-Way on <br />the IE.side of IV be-v r-r~approximately 0 ee ile ..5 <br />of 1.-.)bOT>BQ::r.l>ld=Rd 'Lop:r..,by performing the following work deScription of work): <br />Work will commence on or about 3-7-.2.016 for approximately 'I~V days, <br />I,the undersigned,certify that I am the owner of the respective properly,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 />t.i)~ <br />Signature of Applicant.Tille ;3-/-..2..0 Ii <br />Date