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tl"lIEASIE tl"iliijM1r: <br />Date j;~2 -2o~,6 <br />To;SanJoaquin County <br />.Department of Public WOIkl <br />\"{)7~!EE pf'\Sl{7017Q <br />(A~J,r.~,w?[~~;:&)m.j!p <br />S .t~\61~"i.tJ(~Q e,-A ~(~~DL~=l«:iiiJ,Sffi~e,low.C;)Ji!le) <br />{:u,q:>!n?i-Cjt{32.. <br />{Am@CllliII~.lfe~1!jlID1@i1e~!Jm!lJ~"1 <br />Sketch {Detailed plans may be submilied) <br />tee a.-H<f.ehed <br />OFFICE USE ONLY <br />JOB#13wsJ.-to REF # <br />APIII .CR# <br />EXP.DATE 'l/t5/;ra . <br />VAliD i@&'TO :Jl5/t~DRIVEWAYS: <br />STREET ~iVrl!D._, <br />AREA .Mfli___WAD ~__."TVPE tt/;!:flvumen <br />;, <br />FORMS <br />NOTES <br />. <br />The undersigned hereby applies for permission to excavat1 construct andior otherwise encroach on County High~Right-Df-Way on <br />the S side of W >lLti e ~t tt~approximately I fli ~~i1e~E~_ <br />of N Ie .,~RJ .L t:J D ;r .by performing the following work (description of work): <br />tier laM <br />Work will commence on or about for approximately 1.2 i:)days. <br />I,the undersigned,certify that I am the owner of the respective property,or am quaHfledto 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 3 -..2.-;ao f 6 <br />Date