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, <br />OFFICE USE ONLY <br />To:San Joaquin Gounty <br />.Deparlmei1t of PuibliG WOI](S <br />Of..l,~!)••/J_1 V"p~{I d"\.5 "7D1L.:l._O__ <br />«A~.;ni:;f!~)~;i,iJm~» <br />Sketch (Detailed plans may be submitted) <br />tee 4oH<lehed <br />REF # <br />CR# <br />DRIVEVlfAYS: <br />,', <br />The undersigned hereby applies for pe <br />the .6-side of <br />of LV L /I c.c6 Rei. <br />Rep It>.c.e <br />ission to excavate,cons uct and/or otherwise encroach on County Highw Right-of-Way onr-M approximately :::<0 ee jle AJ <br />L..C>P :J:.,by penoming the following work ascription of work): <br />g)<',ls=b'I\~Pale Itt ~3A.I"eer"d~"",~,a~..n.~R.~'d~.... <br />Work will commence on or about for approximately days. <br />1,the undersigned,certify that I am 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 />;e.o~ <br />Signature of Applicant -Title