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,. <br />20i6 JU~J27 Pi'1 3:I;4 <br />OFFICE USE ONLY <br />.,-.------_."ARE/.\':,Nttli;;OU!\[J/'tt;'~~TYPE 7!IffICarr?eiF-"---, <br />FORMS 55 1-<), <br />I~OTES ..- <br />,J!jif;g .._..P'M :3i1lfl?LG15L______, <br />,Qf\lffJtiJt~[;6'g~f~;;fj~"tij:~• <br />__J:LtLL(fj fAJ,€-$;[la'i(\e <br />(1IIl<li~i!lgJ',€llJimss) <br />f';'t ,'2 Id<A:t,dl d tYJt 4:;<:":{O if <br />(Cirw,Stlte!Zijl CmJe)- <br />b&q'1 s7:S -t¥s.<.,l/1re"Code -re!~!Jl1liliJe!\flIDlber) <br />To:SanJoaquin CDunly <br />-Depmiment of Public Workn. <br />Slmtch (Detailed plans may be submitied) <br />Wori(wilicommencsonorabout '7-tJ -2blif forapproximalely .2.days, <br />"",£r<!JO 1[-20 -.26~6',..I,the underSigned,certify that'am the owner'ofihe respective property,oram qualified to representtlle ownerand agree to do the <br />Wor!,described above in accordance with the rules and regulations of ::lan Joaquin-Goun!y and subjecfto inspection a~d approval. <br />,The undersigned hereby applies for'permission to excavate,constructandJor otherwise encroach on County Highway Right,of-Way on <br />the NC'r+'£,si~9f [;6\;v:\>\o'-'\..RJ 'approximately (7,z.s.feet~P:'-&- <br />.of N i;'ffiMn rc..KJ.,,Li i1JeI4,c:A ,by performing the following worti (descripTIon of work):.), <br />,R.e._pia.,tee.:k>e:'tG'r-t(5 (~/('ted 'f'",leo <br />prJ I!-n ,_~'ve""--v--t.Signature of Applitant.Title <br />?'-L7 -;::<.0 tJ <br />l!Jate <br />" <br />[ <br />I <br />f <br />II[