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OFFICE USE ONLY <br />JOE #73 (JO)'2 REF# <br />APN CR# <br />EXP.DATE (,-IS -I'VAUD 'klQ-f6 TO '-(5"-/6 DRNEWAYS: <br />STREET !"I••riM f -- <br />AREA QUAD '"TYPE "-.-FORMS <br />NOTES <br />, <br />To:SanJoaquin County _ <br />,Department of PubffcWm~s <br />fG~e R",3\061571 <br />V~Jl'~~:~frt%:,bl~m3r) <br />PLEASE PRIi\lif: <br />Date :)..-J -20 16 <br />Sketch (Detailed plans may besubmitted) <br />fee.a..-t"-ta.elrleJ <br />days.for appmximately <br />The undersigned hereby applies for pennission to excavate,construct and/or otherwise encroach on Counly Highway Right-of-Way on <br />the i side of +approximately,L.feet/mile _~J__ <br />of ~,,by perfonning the following work (descnption of work): <br />bJ L/2e--M!A.rfb~Rei I.U.G .'de <br />I.L IQ~-So Er ;if 1M..1 <.-de~l~c.";'f)pdJs 1U wN,s,'de, <br />Work Mil com~e;~~~rab~tt )0 '2.':i 6 -q~11~ <br />I,the undersigned,certify that I am the owner of the respective properly,or am qualified to represent the owner and agree to do the <br />work descnlied above in accordance with the rules and regulations of San Joaquin Counly and subject to inspection and approval. <br />_.o=Q..D~1hignatureofApplicant.rttle -4 -~-2.016Date-_