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F F UI I :!:HL 1 F UF'f•J 1 H WH I ER' _�URV 1 _E FHX NU. :2094E U 195 J a.n. 12 2U04 Ley:22HI I H <br /> APPIJ16ATIOII FOR WCIZOACW=T PERMIT <br /> Dace ,07 7 1 O 7 <br /> ---_ OFVXCE ME ONLY <br /> TO: Sart Joaquin, County LTOS � ='�!/ �gk• �_ <br /> De artaidnt off Apublic Works ADM CF <br /> =. DATE z-I-G23 <br /> V 1\V 1 VALM To Z-/-C� <br /> (Appli.caut Name) - � D�1Al'$s <br /> law • .1�1o�1tAPYA L QDADy <br /> TYPS - <br /> `! <br /> Mailing Address) <br /> (City. 3tata, .Z� ip Code) <br /> (Area, Code - Telephone "a). <br /> sketch ( etailed plants may be submitted) 47' <br /> f• WAS PJA16T-W � <br /> 1W <br /> The Undersigned hereby applies for pexmissi.oa to.excavate, construct aad/or <br /> otherw�•se-oacraach•oxx county»�ghway �.gkt-of-Way.•oa.tbe <br /> of - �- app=ximately a /mile sid�:.oE <br /> following work (desoxx tip]a, of work) ,• � + It bY'pe*rfQru'ug the <br /> I .Y <br /> Work will commence on ox'abezztQ for approximately <br /> ---.._ days. •, <br /> X, the undergiqued certify tkaat X am the owaery of the respective property, or am <br /> qualified to represent the owaer and agree to da the vrork described above in <br /> accordance with the rules, regulations•of Sant aoacuZ z county and subject to <br /> inspection and approval. <br /> S3 tvre £ XpplicaAt Title <br /> riata <br /> +as:rsk.Osiq (6/003 . <br /> . 1 <br />