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!'.1••1_",_i ':.~L <br />S/~\~";);~';~(JU:,-":.":nUI'~TY <br />2015 JUri 20 Pi'!2:!.,[) <br />AIP'IP'UCAlf~l[l~!FOR IE~CROJACHl\!filEin If'IERI1II~lfCc :I,.'J;;Uf)'.ICd 0 R I(S <br />"lEASE "RIMT: <br />Date G~t6 2.(J;;/t OFFICE USE ONLY <br />To:San Joaquin County <br />.Departmentof Public Works <br />etr t E A"l 31 t o(CCi?5q <br />QApt'liic~jil~~amel <br />'1oilo tVesT lA.ilf, <br />(I\~aml1!l AlIJdulJss) <br />f:>i;tz{':k-f:ed,,6ft q~~o if <br />(Cily,Slaief"ZilP'Colie) <br />(:20'(1 s7s -1¥-.5 Z~lAma Colia •JeielP'l1olle Nllllillbeu) <br />SI(eich (Deiailed plans may be submitted) <br />JOB;\'13iJ05i}.-(a REF # <br />APN t CR# <br />EXP.DATE J~ <br />VALID."hili,:,TO I/Ji;'"STREET -;vIZ.;.f <br />AREA £"i trn QUAD ~ <br />TYPE /$k lI'.6CC"nte <br />FORMS _#~.~~~W~I _ <br />NOTES . <br />DRIVEWAYS: <br />.The undersigned hereby applies for permission to exca ate-construct and/or otherwise encroach on County Hlgh~a Ri9ht-of-Wjlyon. <br />the E side.of •.,.appmximately 101.18 ee ile~l'L~_ <br />of 1S,,!{:cek ~~!'L:r.NOEl'.;),by parforming ihe following worl<f escription of work):,. <br />Worl(will commence on or aboul 16~2 7 -2bt K for approximately ;Z days. <br />ErJi)It-I~-2CJtl ...I,ihe undersigned,certify thai I am ihe owner of the respeciive property,or am qualified io represent the o~merand agree to dothe <br />work described above in accordance wilhthe rules and regulationsof San Joaquin.County and sllbjectto inspection and approval. <br />/<et)IJ D -~~rA..A .eo--(SiglJatllre of Applicant.Tille <br />£-16 -;;W{t <br />Dale