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" <br />\ <br />b"UEASE i"l1ill1llf: <br />Date .3~.2-.2e>i6 <br />To:San Joaquin COUllty <br />.Dep@rtmel1t of Public WOIr,S <br />__rb i IE.APi,31l 10230 <br />(!~.pr.ff.:;:(\1~'8;\{lffi'~p <br />';.t&~'C t,;>,~,ft-P,q~~,[;)I.,~ <br />(1CUltj/,sit@tlJ,Zi~C@Ol1e) <br />-l~'>fn"l-QQ3Z.(J\rlJ~C@aJl~-lfel~~!lill1e~!HrI1ltl~rJ <br />OFFICE USE ONLY <br />JOB#75('I}52,-("REF II <br />API\!CRII' <br />EXP.DATE 7/t,,«IP , <br />DRIVEWAYS:VALID ~_rO.:J.f.!£f'loSTREETfloeN!OAI «.0,e-AREA .J:!:l.DI QUAD NtJ " <br />TYPE EMe J1efkame;;lFORMS~ulNOTES <br />Sketch (Detailed plans may be submitted) <br />tee a:t+tt ehed <br />The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-W'll!.on <br />the E side of N T hI)er-t'l=im'\&:f approximately :57 :2.0 &t7mile __4__ <br />of f'<'<!.A 1M eO R D (,.IP If).:r ,by performing the following work (description of work): <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 descdbed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />days. <br />3-..2-~oI6 <br />Date <br />for approximately3-7-.:z..o{6 <br />J.o~ <br />Signature of Applicant -Title <br />Work will commence on or about