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I , <br />PLEtlSE ii'~ll\I1f: <br />Date ,p <2 -.20!6 <br />To;Son Joaquin County <br />.Dep@rtment of Puillic Works <br />__rO-~{E !iq~~'\69 B 70 <br />(tf~~Jn.~g,'[,~~lflm.~JI <br />S t@(j..~CC 'it'.,tf)tifO 9 e{%~t;;=;;p.@~t <br />ItiRlf,S'~t@,il:i~trnlDIlil) <br />l:t.(};t:!J'>.'.n':<ff -<1 <t{.5:&" <br />ltlr",a trnlDIe-1fil~aj»lInili1GJ~jliJmillar) <br />.Sketch (Detailed plans may be submitted) <br />;ee4~"i1(?.hed <br />( <br />OFFICE USE ONLY <br />REF # <br />CR# <br />DRIVEWAYS: <br />The undersigned hereby applies for permission to exca ate,construct and/or otherwise encroach on Counly Highwa Right-of-Way on <br />the '"1 side of approximately >'6 e ile IJ <br />bf eel -+I.e t"&1 cA by performing the following work description of work): <br />Work will commence on or about_~,~I_-~I.£-.2 b h~for approximately days. <br />1,the undersigned,certify that Iam 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 Counly and subject to inspection and approval. <br />J<o~Signature of Applicant.Title <br />3:-3,-.2.016 <br />Date