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,. <br />W'lIEASE !"Rijl\llf: <br />Date ~~2 <~.t>i6 OFFICE USE ONLY <br />To:San Joaquin County <br />.Dep@rtmell!ofPublic WOIts <br />5 t~~aJlc'1i,:'th!/U IJ e,.<::~~fC~DLI~ <br />iiGoit)7,si~~@,ln~C@iDJ@} <br />(:;'I!';t:j )n:%-q~3.£. <br />i/ilw~~CIlIii~•reiC!jlll1@i1@ ~j~miJ~wj <br />Sketch (Detailed plans may be submitted) <br />.fee "'":t+~d-IeoJ <br />JOB!!12005J-lp <br />APN <br />EXP.DATE <br />VAliD <br />STREET <br />AREr~ <br />TYPE <br />FORMS <br />NOTES <br />REF II <br />CRII <br />DRIVEWAYS: <br />----,', <br />The undersigned hereby applies for permission to excavat!construct and/or otherwise encroach on County Highway Right-of-Way on <br />the 5 side of ljJ ::rv-.v-V\er ~a approximately J t!>e mite £ <br />of N IS (;If-tOe!'[,,00 r .,by performing thefoi/owing work description of work): <br />Rep JOIce 1:;:,""$7,'0~Pc Ie <..11.5'1-/lA'T tA.-1I'11 er-R J> <br />Work will Gommence on or about __~3~-~j£...20 I b 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 accordanGe with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />I-o~Signature of Applicant.Title