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bV'I.IEASE ffl'RII\J1i: <br />Date p~.2~.2t>i6 <br />To:SanJoaquinCounty <br />'Department of Public Worksr&~IE P~.3 1l1.1l?O 53 <br />(~~;:ia,s@~~'~~f!ITH!i <br />5 tt'6k t',f),¥!fl e.,Po C(~,;H';;y. <br />(iGitty,S[are,Zi~C;))!l@) <br />S((etch {Detailed plans may be submitted) <br />fee a:H<:(ehec/ <br />JOB II <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />,TYPE <br />I FORMS <br />NOTES <br />OFFICE USE ONLY <br />13aoSz.,-Co REF II <br />CRII <br />8 I I'" <br />~I~'....TO g I l(p <br />bSc;'ltoiJ_~<=r.,q ,i?v-.----rp,d~~~5E <br />9.Slw __r. <br />DRIVEWAYS:, <br />The undersigned hereby applies for permission to excavate,construct andfor otherwise encroach on Gounly Highway.RjLQt-of-Vi£ay on <br />the \Ilj side of GM:.a/cit'1 Be,l!.:rt&&i approximately 0".q fee~_/_I/_ <br />of G A;Y'1!\1',ad ,t:::A'-M 1'"'1Tefl,by performing the fonowing work (description of work): <br />Work will commence on or about for approximately {.<.O 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 />work described above in accor<iance wlih the rules and regulations of San Joaquin County and subject to inspection and approval. <br />;eo~ <br />Signature of Applicant-Title 3-~-.:to 16 <br />Date