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.'r".' <br />Ii'llEtlSE L"lRllili: <br />Date J~2.-2Di6 <br />To;S@nJoaquin County <br />.Department of PulbliGWorks. <br />t?{;-HE ;Rfc'\3 \Ib ~6 (;:>D <br />«tll~w~n!:£!t1~~;;[)m.~p <br />5 ~~.t}e)k:<ci\f7~fFO "te!.A(~t!?t~~D LI~~ <br />~Co!.jf,Sli'~te,IijJ «;;]101e) <br />l~~)!$7;f-q~s2..(tllr,,@Cil101e-'IfeffejJlI1i1lUl"~JnJmilerl <br />Sf(e!ch (Detailed plans may be submitted) <br />tee .oLrl@j ~hed <br />OFFICEUSEONLY <br />JOS#7~-<.o REF# <br />APIll CR# <br />EXP.DATE e,F <br />DRiVEWAYS:VALID ~("~l!o •STREET .re~~.-.,-----AREA .J.,.od i ~~QUAD N 1M <br />lYPE Po\t!ip.cg MA.o,fl-- <br />FO~MS si{ <br />NOlES <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br />the N side of C..•rrel'a oed approximately ee mile~5.~_ <br />of e~+14 V\d R i>L b f>::r ,by performing lhe following work ascription of work): <br />Rep I",ce E)CI'$"UO~Pale <br />Work will commence on or about ~,~J_-~J£-.2 C>I 6 for approximately days. <br />1,the undersigned,certify thai I am the owner of lhe respeclive property,or am qualified to represent the owner and agree to do the <br />work described above in accordance with lhe rules and regulalions of San Joaquin County and subjecl to inspection and approval. <br />J-o~Signature of Applicant.Title <br />3:-3:-2016 <br />Date