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PLEASE /PRINT: <br />Date .B -~-.:z.oI6 OFFICE USE ONLY <br />To:San Joaquin County <br />.Department of Public Works <br />fG/f3,f#l 31lQoStS <br />(Applicari[li~ai11e) <br />4tJ~o wett kne <br />(Maml1!l Adiillress) <br />~to er--WA .<U\q5"~Cll/ <br />(Cit{,Stlte,Zip Gode) <br />(;201.)3?.3 -Cj If 3:2 f>e'd:2€t;Je,coM <br />(tlrea Code.Telephone !lJlIIIIliJe ' <br />Sketch (Detailed plans may be submitted) <br />DRIVEWAYS: <br />jee,..>ke+eh <br />erelV;;-o Cttll.~-SCo L:<oq)1~3-7/-/.2/LiB w <br />/2 t-Lnu"'~be67Jre-Wo,.k 5-t:dr--t'.s~C-r-etO j>iArt.f1 F"eft.<.esf' <br />~1 ~¥"I'\.tU'"C"\eA.~(H'\.ce1I of-I),..d-VUi-work .aA.LN~L<.Ht\fel' <br />1M..btH~j,.No ITe-\,'V\.bBr-"\hMA M<t-".~, <br />, <br />.The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa1.Right-of-Way on <br />the W side of A,;ltIL .••.lj LrJ'.approximately SOC)€YJnile~•.~/lJ~ <br />of _c.A -.0g _~'..',byperformmgthefollowmgwork(descnptionofwork): <br />.- <br />Work will commence on orabou!B ~"'~(-'6 for approximately ~days. <br />.'/~ND '1-/5"-J 7 .I,the undersigned,certify thall am the owner olthe respeclive property,oram qualified to represent tIle owner and agree to do the <br />work describad above in accordance with the rules and regulations of qan Joaquin.County and subjectto inspection and approval. <br />"