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" <br />~I-EASIE Ii'RII\I1f: <br />Date p <2 -:;U>~6 <br />To;SonJoaquinCounty <br />,iJep@rtmel11 of Pulliic Work$ <br />i:U"fl ,-D II /q '-J lJ 7~117 p~Ii ''''1,3 0 " <br />(~~~~n~1!~~~l~m.~~ <br />1',16 eo!/))!Al ,,pA!;~,\t6~:~t- <br />~itR0Gj1~fr'~:£iAf.~I~[J1~'3SS) <br />(2M)!J;;7?-'4Jq3d:.. <br />(lIw@@([;M~-1rli!iejii1l1ilE1~11l!!1i1~~wj <br />SI(etch (Detailed plans may be submitted) <br />tee <:'LoHi-@/ehecl <br />OFFICE USE ONLY <br />JOB#7:txxS'J,-io REF;\! <br />APN GRff. <br />EXP,DATE ~ <br />VAUD ~tv TO ~tl.p DRiVEWAYS: <br />STREET"..Af-~'2t(i,!)%«,0.-AREA .(-Dl:>l ___QUAD ~.M2..._,~ <br />TYPE Rle ~e\t,u-~i: <br />FORMS "3;'~1JiM)[~(}TES <br />N-u:be.t..1J.)('tl'\12.'itCblVl.ff\I;)'i ~(2.DIl-i'::;-r<e.flf"'FIC.()Of;:r;fU:>L O€/lces WrT'rl'N <br />teA,,••..Rol:lc,r<t'='ri,,.-oF,,'>JA'I.:ilt <br />The undersigned hereby applies for /iemJission to excavate,construct and/or otherwise encroach on Counly Highwa Right-Df-Wayon <br />the.$side of 112 A f'1M $+ro "'tJ=Rd approximately..z I e ile U] <br />of N Db{IIt$Rd .LC?I>:L ,by perfomJing tha following work ascription of work): <br />Work will commence on or about for approximately days. <br />J,the undersigned,certify that I am the owner of the respective property,or am qualified to representthe owner and egree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subjectto inspection and approval. <br />;<.o~ <br />Signature of Applicant -Title