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06/12/2006 16:22 2094689:324 SJCO PERMITS PAGE 02I0,;D <br /> ,APPLICATION .FOR ENOZOA.CEN3WT PERMIT <br /> PL &s FRarrr <br /> "SAN 1040UIN COUNTY <br /> Date OW-- VXCE Von O <br /> o�°R OF PUBLIC 'WORK S <br /> ,rd.- San, LToaga3.n County JOB # /1O _ <br /> pepartment of public Works APN CR # <br /> Exp. DATR8 r� <br /> tINA G� .VALID TO DRZWNA 9: <br /> (Xpplicant Name) STREET ,�' <br /> 837. s14Aw 14aA0 AREA <br /> (Mailing Address) FottMS. =r- 1 AC729 <br /> � Cj S2 f S 'NOTE <br /> (City, bate, ,zip code) <br /> 2 0 �l 7 - / E) �O • <br /> (Area code - Telep;hone Number) , • --- - <br /> sketch (Detailed pIans may be submitted) <br /> EE A 1 TAC14ZJD S�� •.PIA4V ' <br /> T6 undersigned hereby applies for permission t•o ,excavate, construct and/or <br /> otherwise.-encroach. on Coxmb •sighwaa -of!�i�ay•oft•the -- aids'„of <br /> pzQx � e3 y - eeeemile •- <br /> of +. byexformin the <br /> folloovingwork (description of:work} : TMQEE C3 ��,Qpts -I-u VTrirUL <br /> f Z w• S FA Ira 4.EdkCL <br /> or KP Acv. . <br /> Work will ,commence on ox'about at 1 Z-0 a itfor a <br /> Pproxi.matel.y <br /> I', the ;undersigned cert i,f'y that I am the .owner' of. the r• spective property,. or am <br /> qualified to represent the owner and-agrea to do',the 'Work described above in ; <br /> accoz•&=ja with the rules, re ule,tions *o£ San soaqu-n County. and subject to <br /> inspection and approval. <br /> oJFt3 <br /> 0)9Si5,7 <br /> —,-- <br /> gigrmt a Apgl.icatst •- Title -- Date ' <br /> • �'RR.1iR19L f5/6of . <br />