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b'lIEASIE !"RII\II: <br />Date ,?~.2 <~.t>~6 <br />To;8@nJoaquinCounty <br />.Deparl:mei1t of Pulllic Works <br />I?tx ~,fE!;Pif1 3 II 7 DoS-q <br />«t%~Jiff.~rL~8~£!m.31~ <br />.5 "~gJl~.Jci'@(tU ,9 e,t~~f~~~Lit~ <br />~«;i"JI,slfuIG,lu~q;il~~} <br />lziJ';Pj)IJ7:;y-q ~32 . <br />(#\w~~«;il~~'r~I~1I1ilfi1@mlllll1il~wl <br />Sketch (Detailed plans may be submitted) <br />'.fee ~H~iC.hecJ <br />OFFICE USE ONLY <br />JOB#'1311<6Z-Ca REF;\! <br />APN Gill!EXP.DATE €{1~10VALID3(c?"{t<"O _eJ!(If.<>DRIVEWAYS: <br />STREET 1J(';l.\It~"S.~• <br />j,cd i OU"iD IitJ -,.----AREA <br />TYPE -dd7lli:.~"/61 tk';I/cesFORMS':?S /p»JNOTES) <br />- <br />The undersigned hereby applies for permission to excavat~,construct and/or othelWise encroach on Counly High~Right-of-Way on <br />the..s side of W g '",'Le,Rd--approximately 2.t>O cfillltAnile W. <br />of t>a \/17 Rd ,5 TOC/<::t"",by performing the following work (description of work): <br />ReplfAce E;.)<,'s;-tifl"l,Pale LI)~6teJ /.\c.ft~o£~t(),.j.d:,M <br />d '.N .~:rCI'2 per-w.,'t .fb,..2--+eWlf ~'fYj>t2~Ccw1t'a &«1 -j)AVJs~/. <br />Work will Gommence on or about.J-~£•..2C>II.for approximately 12 <:l 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 Counly and subject to inspection and approval. <br />;eo~ <br />Signature of Applicant -Title