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APPLICATION FOR ENCROACMMY.r PEM41T <br /> Date = OFF2G� 783 ONLY <br /> TO! Gan JOA quin county ]OB frREP # <br /> Dep&rtment of Public Wexko APRT CR: # _ <br /> /� <br /> /y ;.,Xp. <br /> 3 N RA I L-WA"I VALIDTO <br /> -- -- �_ I1RSV'giQAYA: <br /> "(Appl9.cant: iq&ftp) STR9ET <br /> AREA QUAD <br /> TYPE <br /> (Nailing Addreas) FORMS <br /> fR'ESN_o CA `�372.r5 <br /> ro�� <br /> (City, State, Zjp GSdo) <br /> S S 9 <br /> (Ara& code - x416phono Tu=ber) <br /> Sketch (Detailed plans may be submitted,) <br /> el vt S cb <br /> .�r417� S <br /> The undersigned hereby applies for pormission to excavmta, con0tx,u4t axd/ox' <br /> othexwseo encroach on <br /> y "gbway night-of-Way on the RJR. N "do <br /> W-� <br /> � l£ at �roximatJ0 evt <br /> 3 ' CS R <br /> of caViVT W SM'lTd 6StA0'V <br /> by '�arSorming th4 <br /> fallowing wQrk' (deacription of work) : ,-r&L,&L615 ZO RZ -5 Q;! Ac6 A b <br /> r-,FM ENT PLAPICS , R€ �LLJ6Mjt,1 _ -ASK AA,ib_ AL1(;tl r, C+GK <br /> AN 0 7o_�Hr. )ttN_6 F FOR. 4Qtj- Cor1 TiedL C�TRA'1N,'A0VD <br /> -ENSL F'Y, <br /> I _ <br /> wOr)c wi, l CommeMvR on or about 9 - -°f - 07 rmklu 9�- fea -r-+ for approximately <br /> days. <br /> T' the Lu'r.dersignad certify that I am the owner of the raapoctive pro,Party, or am <br /> qualified to r�present the ownr_r and agree to do the work deacrbed above in <br /> acdordance with the, rules, rcgulati=17 of sffiz Jca.quin County and a Abjact to <br /> inspection and approval, <br /> 9i nature Of Applicesst - Title pate <br /> At,�11 <br /> MM',7Cf1.6.",�Pf3RNCF�L jR�0�71 <br />