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t <br />• <br />PllEtlSIE g>1R1~1: <br />Date ;;~.2 ~.2C>i6 <br />To;San Joaquin Couniy <br />.Deportment of Pu~li;;Works <br />ft>-gil;;:R"'I s I\6~b7t( <br />«~~~J/il.!;i.~~'~[iIlm'3p <br />l:t.<?q,)<n':,;r-51S{32.. <br />(l1Iw~~iGlliDle.leielPlH1al\ijijJ Ul!wiilileu! <br />Sketch(Detailed pla!1smay be submitled) <br />5ee4H~ehed <br />OFFICE USE ONLY <br />JOB IF REF II <br />Af'N CRII <br />EXP.DATE B#f'/p , <br />DRIVEWAYS:VALID "3>(\~UEW/&-,STREET .t:c I fd, <br />AREA t.aI2L...QUAD ---fIIkJ__~.!, <br />TYPE .fde ¥<'e(V).JZ;;:/; <br />FORMS 9:/wvJNOTES <br />The undersigned here~y applies for permi~sion to dcavate,construct and/or oth~rwise encroach 0E.County Highway Right-of-Way on <br />the E Side of lUe.lJe'e'R.approximately a~5 0 @9i1miJe IV <br />of wTu.rl!l 8f""~d ,Le>f).:r:..,by performinrJthe following work (description of work): <br />Work wili commence on or about for approximately days, <br />1,the undersigned,certify that I am the owner of the respectii/e 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 subjecllo inspection and approval. <br />;eo~ <br />SigniJture of AppliciJnt.Title