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04/14/2006 11: 20 2094689324 SJCO PERMITS PAGE 01/01 <br /> APPLICATION FOR V$CR0ACME= PMWIt <br /> pY,�A;9 P1I—W-: <br /> Date l OF8`IGT: U83 ONLY <br /> Tb: Saan, L'oaquin county LTOB # <br /> pepartmant of Public Works APRT CR # <br /> EXP. D,A.TZ <br /> o 7IneU vAL=. TO 17RtV PA3t8= <br /> (Applicant name) <br /> 4 f1m1 ,A.1d�'..5 00 TYPE <br /> (Mailing Addy+ass) FORMS. <br /> 'COTE <br /> 2IPaJ53E�b' <br /> (61t-7, Sta►ta, .Zip cede) <br /> - <br /> (Area Code - Telephone Number) . <br /> Sketch, (Retailed plains may be s'iabtitted) <br /> 0 <br /> VC <br /> _+ 5P, Z <br /> >M <br /> ern <br /> 3 nM <br /> w oa <br /> O <br /> m cn = <br /> The und4traigned hereby, appliez for. permission to .exoavats, construct and/ox <br /> otherwiae•encroach•on-•County-•H:Lghway Right-of-TAy%'9IL'ha. ?�:ide,c# •• <br /> UAI-'*W r kw f / 4oef' — approximately feet/mile <br /> of by Vexforming the <br /> following work Uc -_acri.pticn of:work.) : 2� e�Flectw-5 -_ -- <br /> Work will ,00mmance on or'about for approximately <br /> 4i-mks -A reorf 4&79-. - 6 &.Xe(cs - 4AHON <br /> 1', the -underalgned 66rtifX, that I am the owner. of, the respective -property, or -am <br /> qualified to represent -the owner and -agree' to. do .the viork described above in ; <br /> accordance with. the rules, regulations 'of San Joacl4tL County and subjectto <br /> inspection and apptoval.. <br /> gntkture Arf Applicant TLUS at® <br /> 41rmv nL (6/00) <br />