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F k'UI''I :t_HL 1 F Uk'N 1 H WH I bk St".V 1 CC I-HX NU. :2b'J4b4U 1 y7 Jun. Z5 ZUb r uz:sur ri r <br /> APPLICATION FOR MCROACMOM PE=T �$b <br /> RL <br /> Date-..._ ........-. _.- .. _. 01MIcR.U911,artLY-.._--..._.__._.-.__..,. ..... ............._ - <br /> To: san Soaquin Co=ty 0708 # "730'7?- REF' # <br /> Department of public Works AM Cly <br /> ALM 047. TO° _,.�-� DR AY$= <br /> (Aplioaat Name) sTBB'ER' -,4&/x& Anty_ <br /> .\SSO V -7VMAOW Sfi AR's► : TMA r` <br /> �pR lG 6 � � <br /> (Railing Address) PORMS <br /> S ,o L�.ato C\ 11%5ao 5 NOTL ; <br /> (City, State, .zip Code) <br /> &(3q- xA6'A, 11 <br /> (Area Code - Talepbone kttwber), <br /> sketch (Detailed pla=s may be submitted) <br /> rhe uadarsigned hareby applies for parmissioue to,excavate, construct and/ox <br /> oth,erwiAe-encroach.on County-Highway Right-of-W&y..on•the WUS-T? Si"'..bf . <br /> Of KN .— approximately c�.� a t <br /> byVaxforming the <br /> following work (descri pti= of work) : r <br /> Work will commencer3ou or•about - "�� fox approximately <br /> days., <br /> I, the undersigned certify that I am the owner of the respective Property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the ru]• a, regu Attons'of San Joaga�n County and subject to <br /> inspection and <br /> signature of Applicaht Title Date <br />