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( <br />9'UASE t"~ll\Ii; <br />Date j)~.2 ~2D16 <br />To;S@nJoaquin County <br />.Department of Public Works <br />?0-$E:Per,!~II 6f{J;'t/O <br />~t~.~,r.rr.i::r..(~8~Jfjm.~J' <br />5 tli\&~'C tt)~i rJrlA cf~;e[)Lj~.I_\o__ <br />(iCiltlf,S,ailfl,Zi~~~e) <br />/2.6Q)n?-c,'{32... <br />(J\re~Clllile -lflille~ill]illillll!IJm!lle") <br />8!(etch (Detailed plans may be submitted) <br />fee.A++~e.hed <br />OFFICE USE ONLY <br />JOSti 1'3<.x;'S2-<O jREFII <br />APN CRti <br />EXP.DATE .7 {'~liCe <br />VALID ~_TOjJI5Jlf..,DRIVEWAYS: <br />STREET :mo~c~'O,, <br />AREA t.."D\QUAD _},[JA>____.:', <br />iV?E i?oIe l?epau,'tl'\e-mFORMS9?fwwNOTES - <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa.¥Right-of-Way on <br />the E side of AI TtL"fCt.i"OP\cd approximately 1,£t:>O ~ile_,.v __ <br />of W T"•••i\t:r ,e d Lt>.D ':L ,byperforming the following work (description of work): <br />«.e.p '&tee fo (~. <br />Work will commence on or about for approximately I~O 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 />;<.o~ <br />Signature of Applicant-Title <br />,.~l1CEmRAls:RVlGa\Cl.ERlCAl.JP"~8-SV.WKlW,S1J:R.PS\ENCROAClJMfNTPBlllllT APPtJOImON.por;ilE/13) <br />3-.2-~O'6 <br />Date