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I"lfEP,SE I'IRU\llf: <br />Date ~~.2-2016 <br />To:SanJoaquinCounty <br />.Department of PuftJlic WOI](S <br />\?tr t,~,Pcf1 3 \\6ct 1..15"6 <br />«~~.Jl~,i;~_It1~rt~;8lf[HJi <br />"..f.~""il--d'A,'",I ii),oM'e;;-."~.u:;;\J..<Y'(I.....;.'~""'"'~Vc1~I!v(,~~!_~_II= <br />(tiltlf,SIs!@,ZilQl ~il1e) <br />(:2.MJ1 j .:n'f-q~r32. <br />(I\WSimtlliJ~.rlEiia~IiIlOO~jilfil!li!f) <br />Sketch (Detailed plans may be submitted) <br />,fee ~-H"idAeJ <br />OFFICE USE ONLY <br />JOB#1$1J09--Ca REF 1/ <br />Ai'N CRt' <br />EXP.DinE ____0]l[iL <br />VAUD 31.i~TO ~1+.,DRIVEWAYS: <br />STREET -moet~@'-'>~\,>," <br />AREA l.o~QUAD N!<l--"~---~.rd-..~-.TYPE ~qh1e ." <br />FORMS ~--NOTES <br />The undersigned hereby applies for peffilission to excavate,construct and/or otherwise encroach on County Highw <br />the E::side of T Into r-VI i'o "I<D approximately e He .s <br />of \A I Ll'f"i'ex--R.D L t>0 I.,by perfoffiling the following work escription of work): <br />Work will commence on or about __J~---<J£-2 C>Ib for approximately days. <br />1,the undersigned,certify that Iam 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 County and subject to inspection and approval. <br />!<iD~ <br />.Signature of Applicant.Title <br />3-3-2.016 <br />Date