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DerOCT.18.2005,4. 9�48AM APEX ENVIROTECH,INC. eU`� `4ba_�10 819 P-5 P, 1 <br /> - • - -,.. .,�, ,.M�..... <br /> APPLICATION FOR RNCR0ACHXZ= PERMIT <br /> fix. am &R=T, <br /> 0IFFtCS USE ONLY <br /> r, <br /> To: Sari 1.7caquin County ATOS � 0�5+ REF #k <br /> Department of. Publ4c Wor%a AEN clt # <br /> EKP. DA.TE X15► 'S5 <br /> VALIn -14- To -7-105-0 <br /> i (Applicant Naiae) STREET x sr. <br /> � <br /> 1 Tes � T7C8& W_o&rylal�a.Lln <br /> fr <br /> PAW <br /> (Mailing mdraee) FORMS <br /> p6� PA Vtil : CA q0101 U MOTE <br /> (city ; state, zip Code) <br /> (%67) Ae5I --b!'7 4 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plaits May be submitted) <br /> The uaderaigned lxereby applies for permiaaion to eXcavate, conbtrucc asud./c,,x <br /> omhezwiae encroach on county Highway Right-of-Way on the sada of <br /> ox o £ec ;r�.., h (o approximately 0-yo <br /> feet mile Sf <br /> 1 .t'(r� F ems-►', B <br /> tallorring v�ork (deaar .ptiQn of wozk} i a -a CrAi'x 'extarmi�ug the <br /> �l I <br /> Work Will COMMS 1C9 On or about <br /> dayip, for Approximately <br /> 4h?. <br /> 1, Cbe unaeraloaed certify than: I am the OwaOr Of Ltia reepecGiv* property, as am <br /> gtsalitied to repreaetyt t$e owner and. agree to do the work described above in <br /> accordance with the rules, regulations of Sall ►Toaquin County and subject to <br /> inspecrion ana approval. <br /> Siler*tura f Ayplicanti - <br /> Title -��"� <br /> nate <br /> • -,'��PDi+�CflDL fG/gal <br />