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APPLIdATION FOR F,,NCROAMERZ PEfiMT <br /> P�',rlti'AS��, PRINT: •'''`'�p , <br /> DateOFFICE USX ONLY <br /> To: San �'oa O=ty JOB # 7_ ✓�a 77 RSA' # <br /> ``DePa��rt**m��entt of APublic <br /> Works APR _ CK � <br /> • C��l�dll�V�il• �t�t � 1�h ���V a DATE07 _ <br /> VALTZ 7 o i xo ZlVal&7 • DRXM1#Y9 s <br /> i /� (Applic=t 1+laime) t(� STRUT .. 0 gt# ee Rd, - * _ _ _ • <br /> 1550 W .'VMMW ST Ir1�,N mm —=CA:TT1j QMkD 1�( .....; <br /> TYPE( No/C <br /> (Xailizzg F'oE2MS <br /> Nm <br /> (City, sbate, ,zip Code) <br /> (Area Code - Number), <br /> Sketch (Detailed plaix3a' may ba Submitted) <br /> The uindersigned hereby,applies for permission to'excavate, construct and/or <br /> otherwise•exaaroach•on County-mLghway 94ght-of-way.•oII•the <br /> Of <br /> proximately — -ria a` _ e <br /> IX work descx tion of wox ;, by Imrformilkq the M; <br /> M <br /> law <br /> w62z3CQll commence on or about ` �� <br /> days. •, <br /> for approximately <br /> 3;, the undersigned certify that T 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 ra , regudations'of San JoagW= County azd w bject to <br /> inspection anc! approvaakpQ�-OJ'r <br /> VCS O�( <br /> s�.gxaa,.tvre of A�,apl3caat - �'it3e Dane <br /> XUT=.as z (Ciao) <br />