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" <br />W'lEASE g>111~!\Ilf: <br />Date ~-2 ~2t:>~6 <br />To;San Joaquin County <br />.Department of Public Works <br />leil"!311bq~bO <br />«t\\~.~r.ff,i;c:'[;~~:~ffi.~JI <br />';{(Y4b .,~Q;'!.-,~';'l",:..[,t ..~ <br />~!!1b1[))afi!~:2i "f.~I~~,1J~S)Si» <br />,(2(;1)IJ7?£-ql/..[32. <br />(j.\r;;~Gliliile .•11eil!!iill1lJfllGl~Sllli1iJli!ij <br />SI(elch (Delai/eaplans may be submitted) <br />;ee.4-1M-~ehed <br />OFFICE USE ONLY <br />JOB#'13evSii--c.,.REF;\! <br />API\I CRIf <br />EXP.DATE BP/I" <br />VALID ~/&_TO ..f}{1/L"DRIVEWAYS: <br />STREET '''J:¥.I/is1.d,,----AREA ££:1>/_~~QUAD NbJ .. <br />•• <br />TYPE ~(e 4fluc-e~"..FORMS :syw...; <br />NOTES <br />The undersigned hereby applies for permission to exc'lvate,construct and/or otherwise encroach on County High~Right-{)f.Way on <br />the E side of f)~v:r..>Ref approximately f {370 lfuJt!mile..s <br />of I.1J kei-tle"A4"LAI L D 0 :r.,by performing the following work (description of work): <br />RepllAce <br />Work wiil Gommence on or about for approximately days, <br />I,the undersigned,cerlif{that I am the owner of the respective properly,oram qualified to representlhe 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