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~lIEl\$1EIPRII\I1i: <br />Date OFFICE liSE ONLY <br />To;San ,Ioaqllin County <br />.Department of Pu!Jlia \IIIOlirS <br />PiPl ,5/(7775S- <br />«~~J/ff,~[!T\f~~{lm3p <br />"5 "t~lb-~<C1.\~[t'oJ g e'P£C(~~D~t <br />(~i"y,StJi@,Zu~C!lIl1@) <br />(2.1!>9.)!J7?-Cf![32. <br />(Ama ~ijlil1e.1ie«e~lI1illi!1l\1l!ml!l!1il <br />Sketch (Detailed plans may be submitted) <br />tee a.:t+~~hed <br />The undersigned hereby applies for penn~sion to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br />the G.side of CZo/a et\&a;t~Au e approximately I 2 S-.ee lie ~/l!__ <br />of.g M /'",et-5 -tt2'"k -+bfl ,by perfonnlng the following work ascription of work): <br />Work will commenca on or about for approximately l~0 days. <br />1,the undersigned,certify that Iam 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 />Jl-o~ <br />Signature of Applicant -Title 3-..2-~oI6 <br />Date