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03%19!2007 12:23 FAX 120A3671035 CRV ENTERPRISES 0 001 <br /> 03119/2007 11:03 2094689324 SJC© PERMITS PAGE 01/91 <br /> APPLICATION FOR mmuoaamcm PEM3:T <br /> OFFICK USE ONLIt <br /> Tai San aoagvitx County # 'REF <br /> Depart:maD,t of Public *rke APK C . <br /> C z dZXP. DATE <br /> (AP)►ltseat 1Qame � VALID, .�,.� TO - -- DRXVWAYS <br /> STP9ET E (?Go✓ -, <br /> �U Z AJ; ch(3(s ARRA 4z.v��/ E - <br /> (Mai�is�g Addx�ee) FORKS <br /> 'NOTE <br /> (city,, state, -Zip Code) <br /> 36 7 <br /> (31rs& Code - Telephone Kjn&er). <br /> sketch (DL-tailed plans may be ottbrtlitt,ed) <br /> TiLa undersigned herebyapplies for, permission to 72 1 .ex vats, co a•txuct 3r d/vr <br /> °t 1. 7- oroach-do..county.Highway R�Sr�t-of-Way-�o •the fes. <br /> i ST g�, of <br /> aAproxim�ttely / c9 <br /> of is 6. ., feetit <br /> following., by$e'rformdng the <br /> wor7c (de$criptd.oD cL, woT)t) <br /> work will comrtnae, on: or'ahol�t <br /> ciaya, Lar spproxxmately <br /> I'r the ,undersigned cea tify, that I ani the ,cwaer' of. the xe <br /> a3 ifiad to xegresent the OVAer and agree' to, do .the wor�described4abova�3nr am <br /> acc0rd4Q0e with, the rules, regu•lj�tians'of San doS4t�,•iti n, a. G'6unty ar�d subject' to <br /> iaspe ion approval, , <br /> si94ature of Applicant �`— <br /> Pp ant - Title <br /> Date <br /> N718x'pR,R9�1+RRgC�L (6/sal . <br /> i <br />