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.' <br />00'1"J'U"'i2'0,','I 3:l,3oJ0",I ' <br />",''''''.-)TL-<:..'l,'l'-li Ie WORKSLJt.l I,',I ~.~, <br />Date <br />!"lEASE I"Rlllrif; <br />b-;2.7 -.2et;/6'OFFICE USE ONLY <br />To:San Joaquin County <br />'Department of Public Workserri£.11,"\.3.11f3 ~13:28 <br />IArjlliCai1i~n~mlle) <br />4oL{o lVes-t LaM: <br />(I\~@iHii1!iJAd/dress) <br />f?ttl (ok.f cd!.,6 It-1;;'--::<'0 if <br />(City,S~~le;ZiilCoole) <br />Slmtch (Detailed plans may be submitted) <br />JOB II 15005:J-~ <br />APN <br />EXP.DATE <br />VALID. <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CRII <br />DRIVEWAYS: <br />.The undersigned hereby applies for perm'sian to excavate,construct and/or otherwise encroach on County High':::Jll.Right-of-Way on <br />the !A I side of (\e.r it-Vl e-.approximately 1 2i II0 ~mile..$ <br />of wo.-t ..••.r-!,hD d Ufr .~~,S ta ,ds+bt'i ,by perfor~ing the following work (description of work): <br />Reeu1(:e-Order-teo c<'ded .Pro le1 <br />Work wiJI commence on Dr abDut 7 -If,-2.b t 6-for approximately ~days. <br />ErJD !l-2D-2b{£'.' <br />I,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 Df San Joaquin County and subjectlo inspectiDn and approval. <br />&41 D/"..;;.SiglJatl!re of Applicanl -Tille <br />~l\CEmAAlSERVlCES\CI..ERlCAlJI'UIl-SV.WK\.\lASTffiPSIBICHOACHMEHTI'ERMrr AI'P41CATIOrWOG (O!J113) <br />6 -27 -;;:?(.jt 6' <br />Dale