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"•"" -"L+' �I I +ii wI IILI .t_I,v 1..L 1 fill IYV. GV J`1VYCJI JJ JU1. 1J G_ICJI JG• 1-I II I G <br /> APPLrCAT3:0X FOR MrCROAC T P?2XIT <br /> DAte OP'It USE ONLY <br /> TO: Sasx abai y UOB # *73077 kW <br /> nn Department of Public Works ApN CK # <br /> f��t � 1V 11l' r. DATA <br /> �[ 'R � 1"t`► <br /> ISM t vzzm 7-I ZO) To /d-L07 ORM WAYS: <br /> (Applicant NataEa) STRZ I CMftk%GI1E. .._A <br /> ow a <br /> Q= A43 <br /> TYPE -"3EI L Md LE <br /> AMa4lingpAddross) s r� FoRMS -z M• ,� <br /> @10 NdTE <br /> �(City: ftat�er .Ziipp+�Code) <br /> (Area Code - Telephone Nwmber) <br /> Sketch: (Detailed �la= .may be submitted) <br /> The undersigned hereby applies for permission to,=cavate, construct and/or <br /> Otherwise,encroach•on county.,Highway Right-of-way.•on I the \N aidO bf <br /> CI\RF•1.Ir_A , _ F� V_ approximately ' dee <br /> of ��w l S it , y vexforming the <br /> following work (description of work)N� <br /> ZnA <br /> �TL= <br /> Work�will commence on or'about C�"'I`L ' C�-� .,.. for approximately <br /> days. <br /> x, the UAdexsigaed certify that T am the owner of the respeatri Ve property, or ata <br /> qualified to represent: the owner and agree to do the work described above in <br /> accordance with they ral , regulatio an of S0oaquin County and subject to <br /> inspeeti= and approvaL�OQ`1�."% 77 <br /> sisnatura of Applicant - Title nate <br /> /WTIRit.PD�P'ffiCCDL {6/04) . <br />