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W'llEASIE e"l'l!ll\!lf: <br />Date ~<2 -2016 <br />To:S@nJoaquin County <br />.Department of Puillic WOIitS <br />_rV.~_<E i?J1'\311 6q l.el~€3_ <br />(t!I~~.~r.a.i:~~t~[~~;[)m.3) <br />:>tt'Ok .';"@"1£e,.:iJ!'1i'G'"~<)tI+ <br />(Ciitjr,Sii~lliJ,ZilQ1iGiIJ!le) <br />(:J.;Y:ff)!f7~-qIl.{32. <br />(#\m1;J iGilJliIle.rli!i(!J~1I1i1JJi1e~jl!lmlbJeuJ <br />Sketch (Detailed plans may be submitled) <br />fee «'l.~<,qe-hed <br />OFFICE USE ONLY <br />JOB it 72005!-V REFit <br />APN CRit <br />EXP.DATE ~(p <br />DRIVEWAYS:VALID 1&111e T ,J?~L&--- <br />STREET Ho.("~.lM ., <br />AREA R~d'.-~~-QUf.ID -M!iL..-._,~-TVPE k«e.~eAFORMS~NOTES <br />. <br />The undersigned hereby applies for permission to excavate,constwct and/or otherwise encroach on County Highw ight-of-Wayon <br />the N side of lIj tL~-r "6'Jd L N approximately 2 3 e ile.IE <br />of De\tf"l~Rd ,Lt>D:r:.by performing the following work description of work): <br />Repl"'ce .g)dN,'O~Pale <br />Werk will commence on or about 3~---"l£~;2"I t 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 tQe <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />fi.rD~ <br />Signature of Applicant.Title .3:-3,-.:to 16 <br />Date