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06/26/2006 14:57 2094689324 SJCO PERMITS PAGE 02/02 <br /> APPLXtATION ,FOR ENCROACMMMT PgPjWMT <br /> Dates ! tea( 3-0`.o'P — -- drkxc g. v819 OMY <br /> Tb: Sao Jcm uizi Cc1ln ,y <br /> Dv artmerit o :ic Wore APN <br /> VALTI <br /> � 0 <br /> .(A0plicant Name) <br /> S . C� ' <br /> AR <br /> T'Y'PE 460 x�A lie � <br /> (hailing k i®ee) FORMS. <br /> 'NOTA. <br /> ' fit•;*,���-.�a,T•r..� G• St o'g. • , <br /> (City. Abate,•.Up Coda) <br /> C_ vs. Cyt.-. .} -- <br /> (Area Code y Telephone N1 mber) <br /> Sketa (Detailed plana may be•submitted)- <br /> The undersigned hereby applies for. pexmieHion to,exaavatie, aonatruct anti/or <br /> otherwiae-s roach•on••Couxxty,•-Hi.ghgvay 4grht-•ofWay:.ca-the •of',: <br /> appzbximatel.y .. c� ee mile 5G'V.&4,. <br /> of roh n t m. ' y'performing the <br /> following -wog k (cleeckiption of:work) : <br /> ,Tz) <br /> lr`��s'c�\l c.�►i rnr� Cts �� C\LwCScI g tri� .- n y..`j,\��r •---r� <br /> 1 4 <br /> Work will co►mrienae an o t Acs�_�_. k Z.,�_� for approximately <br /> days. <br /> t, . the un;d4 rkAlgned 4bert3O'that I am tha .owner' of the respective-property,•. of am <br /> qualified t6 arepkeeent..tiht' dvn5.ei'"A ag're'e..to do .the vkrk deocribed above in <br /> adcordance with the:rulers; .re$ul.ations'o .San :704gwin'County and ailbject to <br /> inspection and approval <br /> 5�12l,O t'�178f1d 90 <br /> 9igiiature 'Of AVPllCsnt Title ate' <br /> M3 -MRt =r. t6foot •- yp=�(�y(y• y� }y.•v,r \ <br /> (13A13338 •�'G_5 • t <br /> /0420 coo p1�t�/1,vzu',E � �sTE ilt� . <br />