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, <br />Date OFFICE USE ONLY <br />To:San Joaquin County <br />.Depar1merut of Pullllic \/\fonts <br />_~_6.J!E f>"1 SI/766~!?- <br />5"t&e.I~1,'@iJI'i H ,e,:tI Ci'.G"";!tlY. <br />1«.:Ot)r,si@~~,li~«::l!!iII~) <br />(:?fJ9,);;n~-qer32. <br />INwiil iCj)iiJe.li"lili!![jJIIlIlI1Gl ~Qli11lile") <br />S[(elch (Detailed pians may be submitted) <br />tee a.'l;-~tI.c.hecf <br />DRiVEWAYS: <br />h!OTES , <br />- <br />/The undersigned hereby applies for permission to excav e,construct and/or otherwise encroach on Counly Highwa Right-of-Way on <br />the r-:;side of •.approximately e He AI <br />of 'fi "3A.["a.1II.t Rd ,~,by performing the following work description of work):~"'pla t:e..~'tl'ft't~~fb~le _ <br />Work will Gommence on or about 3-16 -2.<21{,for approximately 1:.20 days. <br />I,the undersigned;certify that I am the owner ofthe respective property,or am qualified to represent the owner and agree to do the <br />work described above in acoordance with the rules and regulations of San Joaquin Counly and subject to inspection and approval. <br />j..o~ <br />Signature of Applicant.Title <br />3-,7-~oI6 <br />Date