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I'(,; <br />IP'lJEiilSE ff"RII\I1: <br />Date iJ ~.2 -.211>16 <br />To;SanJoaquinCounty <br />,Department of Public WOIirS <br />5 t&\eJ~~J;"@(~!J e~~r!1t~$1f)~~1.. <br />(tiU:y,SW!@,lir !:O]!J~) <br />l2.i??I),;n::j'-q ~3'2.. <br />(I\w@~Cl1lJiiiI~-flil~e!lJ)jill"U1il ~J!lJil1!l~w) <br />Sketch (Detailed plans may be submitted) <br />sere.,.t:H~ehed <br />OFFICE USE ONLY <br />JOB#15ClD5?--&REfit <br />APN CR# <br />EXP.DATE ebglaVAliD~(I;;il"T .-eJl/&--DRIVEWAYS: <br />STREET 1('1Jf sr., <br />AREA ~...IaVJ)QUADS:s :'; <br />TYPE ~-~._' <br />FORMS 2'>ww . <br />NOTES <br />The undersigned hereby applies for pelJJ]ission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the <;side of g Ut.J..~,..approximately SSO emile .....,(Alv <br />of 5 B >f",6 tl2~u\,by perfonning the foJlowing work escrtption of work): <br />Rep I!liCe.E:)CI'S'UI\~Po Ie .1"1be &/I E ~ <br />Work will Gommence on or about __J~-~I£~.2 C>itS:for approximately days. <br />I,the undersigned,certify that Iam the owner ofthe 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 County and subject 10 inspection and approval. <br />j(r[>~ <br />Signature of Applicant.Title