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• <br />PLEASE !"R1I\l1; <br />Date 3 -2 -2~16 <br />To;San Joaquin COunty <br />.Department of Public WOIt-s <br />fb H;:I?#\3\\6'33l.{~ <br />(Af';v~:l%t\!m,31 <br />"I64.t>i4,J t~(,"'\l,mi-L(~;~~~;~lt~~~1]Ss) <br />$t&'a-k i'M ,e.~qG""~o\{- <br />(Ciay,Si-ille,liiJl COOe) <br />/2.bf1,:>ni%-9Ct•...•3=2.~_~__ <br />(Area iCOOe -lre/efilhone i\IaJrnIm) <br />Sketch(Delailed plans may be submitled) <br />tee.4++4ehed <br />OFFICE USE ONLY <br />JOB#lS()o5'().-(o REF II <br />APN GRtI <br />EXP.DATE ${tc.VAUD E/.t~"t,,~sl,(I/o DRIVEWAYS: <br />STREET iX4 6a:dtv,~~• <br />AREA 17""W QUAD 510 , <br />WE ::;!!::Tro.nili'"",r • <br />FORMS <br />NOTES <br />The undersigned hereby applies for permission to exca ate,construct and/or otherwise encroach on County Highwa Right-of-Way ontheE;side of ::J<l'*.w ~approximately ile .s <br />of Depot Ma G+er--,:n-:",c'~'by performing thefoilowing work description of work): <br />Rep I"'c.e'E."/N,'O~Tea PI$T-tl rIMe,....C PAd ,NI"a V!""] <br />eM k ,1'1 fr-iHI\7."f'2825"0 "'T2>Po Wock <br />Work will Gommenceon orabout for approximately 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 />j(.o~ <br />Signature of Applicant -Title <br />.. <br />I.UtEmuts:RVi~1'Iim'A~/lClI.'I.ENTPmWrIJ'i'm:..'1lO~(mit:) <br />3:-3,-~aI6 <br />Date