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APPLIC,hTioN FOR ENCRoACMOMP PACT <br /> pLx'n8� PRS*"'+ <br /> Date 1 <br /> --��' F7� <br /> OPI?XCR.RSB.. <br /> To-, San abagesin Coeetzt, <br /> Deepartment of zxblic works Z1 �,APDT <br /> �VA 1 O V�t ATUN � ' - 5ad <br /> l ' <br /> dc�TSaniso W� .�1ot ' 1 .. Q ---Wailissg Adds:asu) -7--�,• <br /> S�-ozX- o1�1 ZA "z a0 5 <br /> (City' State, ,UP Code) <br /> (Area Code - Talephosze Ntiuo�er). ' <br /> Sketch (Detailed plana''n'W be ,submitted) - <br /> Tic' undersigned hereby applies for <br /> Otherwise- oath•on "Inty- permission, <br /> zra 4ssioa to.excavaCe, aoaxsCzaet atyd/or <br /> y �ghway xtight-of-Way.on-Che <br /> of ------ aPpxoxitnat ly 1 f a side:.o <br /> allowfxzg wo k`(description of woxlG :� � by Vex-Rorming the <br /> Work ` <br /> Will. COmme=et on Or'c'2bCittt <br /> days, for appraxfarate]y <br /> I, the uudersigved certify that x am the a owner of <br /> '�ai.ified to represent the owner and the respective propert <br /> accordance w�Eth the r gree to da the wy, or Arte <br /> work described, abova in <br /> l�tti of Saxti �'aaxx County and snubject <br /> fnspto <br /> ecGxon anti appzava�.. 4"t• ,"�-p • <br /> IUr�tnf AppXiesgt 4 <br /> wi tle <br /> �waa�oe.aa�aa�y ie/ao) I?�,te <br />