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I RUI l..nL 1 r VECIY 1 n INn 1 Cri JCr v 11.0 r nn IYU. .GCJ7Y04✓J17J JCf-'. CU GUU v -li I c.. <br /> OPLTC&TXON FOR RNCROACM4=T PERMIT <br /> PL A.SE PRIM <br /> # 7 <br /> Date <br /> OFFIM MIC MY <br /> To.- sa.0 joaquin Co=ty "Toll:. 73 C> 7 RBF # <br /> Department of Public Works April !S4- 3-7 Q '.3 y # <br /> • CP1�1F�����1'����� ��.t�V, <br /> M. <br /> nAaC13 I I-LG-6'T <br /> V,MTM, -24- TO -U-0 <br /> (Applicant Name) $ tS.T A AA 1 N R <br /> TYPE - 15ELL. <br /> (Ma.i.11uq Addraao) »Ms; -2 <br /> -SkM,` _OSA .3 U\ is&0� NOTE <br /> (City, bate, .Zip code) — <br /> (Area Code - Telephon fiber), - <br /> Sketch (Detailed �lanz may be submitted) <br /> The undersigned hereby applies for pe=jssioa• to.excavate, Construe 0r <br /> Othexw,ri se-ea=Oaah.•on County-Highway Right-of-Way.-OR•the �Yr3p of <br /> `► \�+.\ approximately ,� ; <br /> of �X 1 _My" �r -- ' by'pBYEorating the <br /> of lowing work (description of work) <br /> Igg <br /> YQ <br /> O <br /> Worwilx cOMMaCe on or'about 'O for appz axzmate�. . <br /> days. •, <br /> Z, the uadersigaed certify that t am the owner of the respective property, or am <br /> qualified to repreomt t:be owner and a9Xee to do the vrerk described above: in <br /> accordance with, the naeg, regulations'of Sash ToagLz = County and svbjeat to <br /> inspection, and, approvax ���, -Q�� <br /> TA - <br /> Si,g4atura of Applica - Title 17a�te <br /> anss.�.vslas�sasnz cc/aaj ' <br /> I <br /> 1 <br />