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I'lLiEPlSIE l"'RIN1f: <br />Date ,3~2-2t>R6 <br />To:S@nJoaquinCounty <br />.Dep@rtment of Public WOlin, <br />fb~,~:(1;(1 3117Ut3 <br />«~~.~r.IT,~[!~~~;i[,m;l) <br />"iriS>£.10 ,W-,~Go,~l6"'~'~ <br />-i~tQ[i~arl!~:0ir~l;f!fD\J2JS~» <br />5 "Cct18k It.\f)~I!e,.~~4'~~D4~ <br />(titllf,Si~!e,li[pJ iCoiile) <br />(u,fJI)in''1-q <t 32- <br />(i1we@ C@iiI~.Tlffiieijllilioile ~j!!ll1lbewJ <br />Sketch (Detailed plans may be submitted) <br />>ee.@l;t-+<lc.hed <br />OfFICEUSEONLY <br />JOB#7SooSZrfo .REf # <br />APiIl CR# <br />EXP.DATE _BN,I" <br />VAl~2lL~/(p .TO!e1'j-JH!<_--DRiVEWAYS: <br />STR>:ET _~ide(lGde oJe.., <br />AREA <::bckJo....QUAD Ds ,., <br />TYPE 7:'1/e &-fhc,,-~.. <br />FORMS ;>(ww..NOTES _. <br />. <br />The undelSigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highwi!.Y Right-Df-W;lY on <br />the 10 side of {yeA deil 6-a:te Av approximately 3£30 ~eD'mile~/II~_ <br />of c M i(lBr-A"S To CicIO N.by performing thefol/owing work (descnption of work): <br />Work will commence on or about J_-_{.£-.2 (»I b for approximately days. <br />1,the undersigned,certify that I am the owner of the respective property,or am qualified to representthe owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />j.o~ <br />Signature of Applicant -Title 3:-3-.::w 16 <br />Date