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, <br />PLEASE PRINT: <br />Date '(-7 -.2.016 <br />To:San JOilquin County <br />.Department of Public Works <br />fG Ir=..&..:?\L B :3 6'6~ <br />(Apl1liGarnl fiIlame) <br />40 ~£;W e~t-t L..cl\e <br />(M~iiirn!ll\l!lilr;;5S) <br />.s>t 0 *-t.o ".fiJ\Cf £,-.:::t CJ1./ <br />.(Cilf,Siale,lilJl Colle) <br />bo<:{}3 '?-e,,';;>rx.<.1:2 €.<e,(1b'''l <br />(Am@Corle.reie[fll"loile mllm!Jer <br />Sketch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOS#73CXJ9.(p REF# <br />APN <br />lll;~~ <br />CR# <br />EXP.DATE <br />VALID./tP,"DRIVEWAYS: <br />STREET J):)tma>?'Wn.I ." <br />AREA '/f"QUAD ME - <br />TYPE ~lR.f#liUL-J'1'U1Cf - <br />FORMS ;;1..)../. <br />NOTES I <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi9=i9ht-of-way on <br />the N side of 6 k:e++le.lM?t!1 L..,J approximately Itt s-7 ee ile t<! <br />of :SAeJs;.To 1\e f2 d ,L.0 /)"J;:.,by performing the following work (description of work): <br />Rep!A.ee'De-terfhl'4te4 .Ii?Ie I ;;;:;::0 "'"fC"'i:-f(~•••If"(I\ <br />Work will commence on or about "/-::2..1).-;:lo {I(.for approximately 2.days. <br />I:END 1I~2o-Aot6 .I,the undersigned,certiiY that I am the owner of the respedive property,or am qualified to represent file owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />~.1 Dt:t~'Si{lIJiltIii'i of App!icam.Title <br />~t\CHrrRALSERIllCE51CLERlCAL\PUEhSV.WK\'W1STERPS\HICROACI-tV.ENT PERMrr;'PPLIGAllOI'I.[lOG ((EI13) <br />7-7.--2.bt6 <br />Dale <br />"