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II"UEAS[1I"1R1l\li: <br />Date OFFICE USE ONLY <br />To;San Joaquin County <br />.Departmei1t of Pulllic Works <br />fb ~lEE 1'11"\31 ~O!b6'~ <br />€~;~;;r;n.i:;fl~~2'Qm~} <br />r'i6 e-{0 ILOe'i?f l6~i'I~ <br />~N,8G!)~r:i!~:;£itf!I~;~,1;005$) <br />5 t&6\~tOilj ,e,.f!l q~~oY= <br />lCiiIty,S~ie,Zi~CIlJ!lJe) <br />(2.d?1 )?n?-Qi.{32. <br />(Area iCil!lJe.Ii!HG!JJlIlilloo U\!1!m!ler) <br />Sketch (Detailed plalls may be submitted) <br />£ee .a.;t+~ehed <br />"'30uS<.-~REF # <br />CR# <br />DRIVEWAYS: <br />The undersigned hereby applies for pennission to e?vate,construct andior otherwise encroach on County Hi9=i9ht-{)f-way on <br />the'~lu sideof .5 Ahe.a.1'1I\~approximately£00--J{?t2CJ ee He NM <br />of W Letl.lM.o>l eL .T RA-0.1(,byperfonningthefoHowingwork(descriptionofwork): <br />Work will commence on or about <br />S't'1JIIp 102'1, <br />"2(;d<:-, <br />~.A ke.rrn I.I $(~II\<?!A UJ '-~""~ <br />a J.J '<t.(!e k:\*'{\4 l+ra lAC;&0 OJ <br />for approximately __l_2_Q -days, <br />I,the undersigned,certify that I am the owner ofthe respective property,or am qualified to represent the owner end 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 />1-00-,.:.. <br />Signature of Applicant -Title .3-...2-~oI6 <br />Date