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, <br />Ii'lEtlSE Ii'Rllili; <br />Date iJ~.2-.20li6 <br />To:S@nJoaquin COunty <br />.Department of PubliGWOIks <br />Ai¥\.31170/2.3 <br />~~~~;r.~'~:lt~~[~iJITE~JI <br />~.f6 1./t2 .LV-fl-!t:,'L",1~,,L!rwJ£J~~f,i!-;;0Jf~liilclli"<:)SSi) <br />5 t~'.6-k'£'<:>1/11 l e..p;,Cj~~i2 Yb <br />(tffli.y,S[ll'~,Zilll[;oiDll!1) <br />(2M).'J7~-qq32.. <br />(J\r~CilJiDl~•ilEilejlll1Olill!1~JQJmJile") <br />Sketch (Detailed plans may be submitted) <br />See.a.."t+,qehed <br />OFFICE USE ONLY <br />JOB II Va(),2.~~REf 1;\ <br />APN GRit <br />EXP.DATE 15''/(" <br />VALID ?Jifl.i~(;;"+-'-o <br />STREET ~ <br />AREA ~_QUAD W <br />T'fPE r-::6/e !feLJha:m,w:i <br />FORrllS 9"/ta~W~/_ <br />NOTES <br />DR/VEVilA YS: <br />I <br />The undersigned hereby applies for permission to exqlVate,construct and/or otherwise encroach on County Hjgh~Right-of.Way en <br />the W side of Pe VcrI 'e>~approximately 7 L-{0 ~jJe.s <br />ef A i'"VI .;;-r-C1I\@rRd __,L./2 D I ,by perferming thefollewing werk (descriptien of work): <br />Work will commence on or abeut 3-7-2 a {75 fer approximately days. <br />i,the undersigned,certify that Iam the owner of the respective property,or am qualified to repmsent the owner and agree te do the <br />work described above in accordance with the rules and regulations of San Jeaquin Ceunty and subject te inspectien and approval. <br />;eo~ <br />Signature of Applicant -Title 3-~-.::to16 <br />Date