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IJl'llEASIE IJl'Ril\ff: <br />Date j}-2~2c>~6 <br />To:San Joaquin County <br />.Department of Public Works <br />?6-~E f~3117705"'>~~~n~!~~~~r:.irm~j) <br />S'l",we-k 1@o1iJ ,e-,A C1tG""~.,I.i,i. <br />(Gilly,Si~~e.ZUIIJlQlllOie) <br />(2M)nf-q~32. <br />(Ariliil ClllOie -feii!jllililillil ~jl!!l1Iber). <br />Sketch (Detailed plans may be submitted) <br />tee-.a.-H<{ched <br />OFFICE USE ONLY <br />JOBt,!'13<>652;-<"REF # <br />!,PN CRt,! <br />EXP.DATE 7j/~7£ <br />VALID 2./$-/".>rTd~5-(t'"DRIVEWAYS:STREET /YCKUVMM/£AVE , <br />AREA 1Jtof.N71J1I/QUAD A/1.tJ 1, <br />TYPE flIle fe/J~cem(J..+-----" <br />FORMS s;p.vw'NOTES <br />The undersigned hereby appliee for permission to excavate,construct andlor otherwise encroach on County Highw Ri9ht-of-W:%on <br />thef:./U)sideof fA)Mt>ke.luWI 1'Ie.Aile approximately e ile AJ,uJ <br />of /I J N\.an 611:C--r ,Tko r"fe>t'.,by performing the following work description of work): <br />Work will commence on or about for approximately =----1-#';2:=-<100_-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 the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />!<o~Signature of Applicant.Title 3 -..2-~O ,6 <br />Date