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PLEASE 1'~ll\Ii: <br />Date ;J <2 -2e>~6 <br />To;S@nJoaquin County <br />.Dep@[lmsl1t of Pu!Jiic Works <br />f'&i IE B""3 tl7 /,tt, <br />«~~~n;;,,%'t{;~~:~f[t'}P <br />$,t&6-k .l'tJriI','I e,A q~~CJ~I~ <br />liCIiltlf,SilJtlJ,ZUIDlC!lJll1e) <br />/2.tpq,)n<5-Qq32..lAma Goo~..lfei~dlll1!!I1Gl~Jllll1il~") <br />Sketch (Detailed plans may be submitted) <br />See.a:He{cJAed <br />OFFICE USE ONLY <br />JOStI 73xJ~d.-("REF # <br />APN CR# <br />EXP.DJWE '1{1~~I.. <br />DFWEW,~YS:VALID ~~_0 '1ki,l.. <br />STREET GdJeJ'l.~#-,.. <br />AREA s.:kdd-o~QUAD 5 " <br />TYPE -SPit:.~OC~Mg,d- <br />FORMS 'If?7ww <br />NOTES <br />The undersigned hereby applies for pemJission 10 excavate,conslrucl and/or olherwise encroach on County Highwa Right-{}f-Wayon <br />lhe';side of Cr"IdelA 6-a +e.Ave approximately 3 q 0 ee iie III <br />of Fa 1\1\,'.tI.'E'....Ave,>-tael:-+oM ,by peIfomJing the following work ascription of work): <br />Work will commence on or about for approximalely days .. <br />I,lhe undersigned,certify that I am the owner of the respective property,or am qualified 10 represent the owner and agree 10 do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject 10 inspection and approval. <br />J<o~ <br />Signature of Applicant ..Title 3-~-.2.0 10 <br />Date