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OFFICE USE ONLY <br />JOB#15WJ fjJ..Cc REF#•APN I'CR#EXP.DATE <br />VALID,~'ln DRIVEWAYS:8/3111(.10 )./tlJ7 <br />STREET ""1W>t '"c<c\..I <br />, <br />AREA •~(V\~QUAD N.~ <br />TYPE fhk.~~\~, <br />FORMS ss\W'tJ , <br />NOTES .; <br />To:San Joaquin County <br />-Department of Public Works <br />!'lEASE PPJNf: <br />Date g-23-z016 <br />fG I r=.&t 3 \\~;7,6 <br />{Alllllica!lli w~e) <br />tflJ'ICi vJe-tt kr.e <br />(I\~"D~ii1gAdidress) <br />~-tber-.-to",<U\q~-~ol./ <br />(CitY,Stille,Zi~Code) <br />boQ}3?.3 -cq'f32 r~d2ef{Je,C!<?M <br />(Area Code.reiejJtnolle IIlUlilloer <br />SI<etcn (Detailed plans may be submitted) <br />See-5ke-+dr.. <br />C relV -to Gt{II '.f-:I 66 C2 0 q )1;-3 -71.-/2/L.lB w <br />72 t-Lt,>(.u--.>be&ore.--WOO'*:5-t:dr--tS~6r-eIO j>fA..Q..fj I"ef~ <br />'tR<'t.I'"e-\eeU~(H'l.c.e..lI rbr &i~c.Uor-k k\'"'~""'~Lvct,f8l' <br />,/VL,6q-i:lA.$-AJoV'e.IM,be.1'-rkf'l.l M4.,.-~, <br />,The undersjgned hereby applies for permission to excavate,constr ct and/or olherwise encroach on C;ounty HighWay~'ht-of-Wayon <br />Ihe E side of :-t .-.approximately 19,6 fee ii A.J <br />of •,-rh&•...1\-+6£-\,by performing the foilowing work (descnp'ion of work):R..e=fl4..Ae De-terrnhde.4 ~fble '2.7(i?G:1 ''TkU2t!'-!1TOi'l.g) <br />WorI<wiJi commence on orabau!&-3\"-lb far approximately '<..days. <br />IE NJ)1-..36 -~7 'I,the undersigned,certify that 1am the owne(of the respective property,or am qualified to represent Ihe owner and agree to do the <br />work described above in accordance with Ihe ruIes and raguJations of San Joaquin-County and subjecllo inspection and approval. <br />12~Dt!l~'SJ9natllre ofAppiicani.Title