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PLEASE G"RIf\li: <br />Data ~~2-20ij6 <br />To:SanJoaquin County.Department of I'ullli!;Won~~ <br />fil"\3>I (;)~"1 'I 3~ <br />~tf~~Jrlu,~IG1~~r~m3'j) <br />S '~G'c-k-t@1'/l ,(!...jJj Ci ~,;wleii- <br />(iGilty,5'""e,li[l»C!I@1e). <br />Sketch (Detailed plans may be submitted) <br />See.,a..:H<{e-hed <br />OFFICE USE ONLY <br />JOSti ~d--~REF # <br />APN CR# <br />EXP.DATE BI#,'~DRIVEWAYS:V.I\LIIJ _-*lik-Yl:BL//(<> <br />STREE1 .C~Iu>me!\!16:>... <br />AREA ~___QUAD ~__"_ <br />TYPE ?<>l-e rloZr~...b.llil<>c..••..-!,i,"'S> <br />FORMS s-:'/ww <br />NOTES ,_.. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way ontheViisideoffI}('.,1>1'-'%'M ill R",J approximately J..e iIe ";' <br />of )tJ L ,,,:,,,,e..Rd T r A (:,'(scription ohlork): <br />Work will commence on or about for approximately days. <br />J,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 subjectto inspection and approval. <br />f-o~Signature of Applicant.Title <br />3-...2-~O 16 <br />Date