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'. <br />2fil1i JUN27 Pi~3:1.4 <br />Dale <br />!.'li,:.il;iE &)RIMI:, <br />r:;.~2.7-,269/6' <br />To:San Joaquin County <br />-Deparlment of Public Wor/(s <br />4 {lLit)tU-e,$c/"L",Ult'. <br />(Mailil1!j f.\lli<tiress)- <br />£;i:I?e),<::--f v Vi ,ej.j-1.5:>'-'2.,t!)if <br />(Cil.\',Siat~;Zij]Cfid,~l <br />12 bqJ s7 ?,~ttl-is -Z\~\re@Corne"I el~iflho~el\lllll1f]er) <br />Sketch (Detailed plans may besubmiffed) <br />OFFICE USE OI'ILY <br />JOB Ii 73005a.-<o REF#:. <br />APN GR# <br />f.XP,D,~TF.~ <br />~~::"~~'tJfIiIi'_DRIVEW,4YB: <br />A[,EA ._"!f\"lUf\D --ffL __,--- <br />.------TYPE ~d:.- <br />FORMS.SS/w-------- <br />NOTloS I- <br />-Th.e undersigned herebyaP.p.lies for permission to excavate,construct andlor otherwise encroach on County Hlgh~Right-of"Way on <br />the SQcl'IA side of;;;Aco...W\j2Q 12d .approximately t!,d(}O~mile Msf <br />of N jo\,t",-::\oV\.X'd .,/..,.0 di ,by performing the fOliowing work [description of work):., <br />Workwiiicommenceonorabout 7 ~II -C-2{)t6 for approximately :2.days,raJOfl-aD •.•..Ml£', <br />I,the undersigned,certify that I ali1 the owner oflhe respectiVe properly,oram qualified to representtl16 owner and agree 10 do the <br />work described above in accordance with the rules and regulations of San JoaqahGounty and subjectto inspsctionE\nd approval. <br />(ZJ2J OrA,,:"Signawre of AppliC~nt -Tille <br />6 -Z 7 -;?()I ,! <br />Date