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~llEIiSIEg>~~M": <br />Date ~~.2 ~2~~6 <br />To:S@nJoaquin County <br />.Deportment or PlI!lliG WOI](S <br />_~\?b-~.'E rPiP'I:3 1 (70::<I 3 <br />«ff~~J/~,~;r!~~~;I[rm~Ji <br />I'd6 /.[DJiJ...;0'A~l,'tat ',~L <br />1~tQ[J::D~r'~:£iif.~I~il:t"~5'SJI <br />5 t@ld-~~T@E¥O fL rf!!..{,~C:i:r~D~~= <br />(iGvity,S[~!e,Zn~ti!!JIe) <br />(:i.If4,)fn?-"1''is:£.iArn~iG0JiiiJ~.rellSlDlIuillfi1llilfi1llJlmil~HI <br />Sketch (Detailed plans may be submitled) <br />tee ""t:t{-<j rf;hed <br />OFFICE USE ONLY <br />JOB it 73(j()5a-0 REF # <br />APN GRit <br />EXP.DATE B~ <br />DRiVEWAYS:VAliD -W.?"l/tpo mil/I&> <br />STREET U/'S"'"tal • <br />AREA -Lod;.QUAD IJW ,', <br />I1YPE---"Poie-&ptva&w't.---."'FORMS 5¥/f.>M)[~()TIES <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way ontheAJsideofLt'-.('5@#\Ret approximately 1:200 ..~iie lAJ <br />of hi D/I.V ,'$Rd ,LaD:::r:,by performing the following work (description of work): <br />Rep IMe E)(llVUO~P",le \"lq5"L••N!H\I?l> <br />Work will commence on or abDut_~,~J_--,l£-.2 C>I 6 for approximately days, <br />I,the undersigned,certify that I am the owner of the respective properly,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 />J-o~ <br />Signature of Applicant.Title