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f .~ <br />1"llffiSE I'~I!\IT: <br />Dale ~~2-.2c>i6 <br />To;San Joaquin COllnty <br />-Department of f'ulllic Works <br />!?6?~rE i?"'I 3/ltq17t1 <br />._-(t~~.Ji~.i:G£i'~8:'~liIF~p <br />(2¥1,'>~;;r-<1~ls2. <br />(tl\r;;~iCiliiile-r(il~ej»lhilJilGl~j!nii1liie"J <br />Sketch {Detailed plans may be submitted)_ <br />See .al..i-htl.ehee! <br />OFFICE USE ONLY <br />JOB#-13::09--<0 REFII <br />AP!II CR# <br />EXP.DATE e(l~DRIVEWAYS:VAliD ~\II&>TO [31j0 <br />STREET ~Sf ." <br />AREA ~QIJAD~,~ <br />TYPE 'PokR<>i*~'".FORMS ~wNOTES <br />The undersigned hereby applies for permission to excavate,conslructandior otherwise encroach on County Highway Right-of-W<}y on <br />the N IIA/<Sid!rut C",..(I Ie r-__aDDroximately tv !It feetlmiie fJLII <br />of r p,'tI e-a iJa est:!v\I et\=ta,-Th.kJL 1;d /1\I performing the foiIowing work (description of work): <br />Repl"'c-e J:::.l',l~i''o~Pale.NIUJ C--IJrAet p/•.•e IUd.rko,d-OOMe.(lro <br />Work will commence on or about __J~-~~£,,".2 t'2 I ~for appmximately 16 Q days. <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified 10 represent the o\vnerand agree 10do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subjecllo inspection and approval. <br />;<..o~. <br />Sigriature of Applicant.Title <br />3~3-~oI6 <br />Date