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e>lEASE U"RII\rr: <br />Date iJ -7 <It>16 <br />To:S@nJoaquin County <br />.Departmeflt of Puillic WOlb <br />g!;;q 3'16 2LJ {L< <br />Q~~J/~.~{):'~',~~{,m-3J) <br />S \',9d'-:.:t@i!fv I <t:£-',~f!:J q';;-~ti),,+ <br />(lC:uiI.}7,SIiiJItGl,ZiJPlIC:!!iJ1li1) <br />(2M,)~?-qq32.. <br />(I\f~~Q»iil~.ieiUliPJlI1llJiU~mii!iifill~"l <br />Sketch (Detailed plans may be submitted) <br />See 4 -I:-&-<¥.ehecJ <br />OFFICE USE ONLY <br />DRIVEWAYS: <br />I <br />~ <br />The unde1jigned hereby applies for permission 10excavate,construct and/or othelWiseencroach on County Highl.:'lYRight-{)f-Wayon <br />lhe_~"i~__sideof W ANII)t:ir-oIlQ eel approximately 71j8lfuJl1/mile W <br />of L-f)wee-$(21C'[-4 lMev.to f?(jif Lo D:r..by performing lhe followingwork (descriplion of work):.~e.p Itl t.e..#'il f-tt'~~..-...ff:,.•••..•./~e ._ <br />Workwillcommence on or aboul .3 -\,(-..2 C>I 6 for approximately 7;ZO days, <br />.END 7-1:"'.2.016J,lhe undersigned,certify thai I am lhe owner of lhe respective property,or am qualiffed10represenl the owner and agree 10do the <br />work described above in accordance wIThthe rules and regulations of San Joaquin County and subjecllo inspection and approval. <br />f.o~ <br />Signature of Applicant -Title <br />3-.7-.:wI6 <br />Date