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— <br /> _. FAX NO. 20946:40195 <br /> Jan. 14 2000 0'-:7=PM P 2 <br /> APPLIC.&xraN FOR ENCROACM=T FEMaT <br /> PTAx LORM; <br /> Date orrim USE OMY <br /> To: San Jcaquiu county JOB <br /> Department of Public Works APR <br /> V24L pC7 ly1t�V$VP - <br /> (Applicant Name) ST S' °' �J;`, � ATS z <br /> MR <br /> ��ff <br /> O, Wailing Addroso) FORMS7-5 ---�"" <br /> stmy' \\ �' �\ l5 @,0 :s NOTE <br /> (city, Saato"Zip code) <br /> (Area Code - relepho je Number) <br /> sketch (1Detalled plats may be submitted) _ <br /> The aadez;signted hexeby applies dor . <br /> ather�rise-e�facroach• pexmiss�.oa to,excavato, ro�rtxaet and/or <br /> ant County-Ftig away Right-of-Waty•oa-tbe -\N�.S <br /> approxiaaate�.y7 ST <br /> �'Q� �'��'�• . <br /> f0llc by-ve'�'P'fsrpt nq the <br /> w �d�description 4f work) <br /> Work will commence <br /> r00 days.. for approximaceiy <br /> Y, the undersigned certify Haat I am the owner, of the re�sect3.ve property, ax am <br /> �a►iiEied to repzesextt the owner and agree to da the work ect;L e <br /> accarda�ace with the xu.1 s, r abovm in <br /> . t�ous'oP Sau, 'Toaquhu CO ty and sub eat to <br /> inspection and approv@.l - <br /> Signature of Applicant - Title --- -����r <br /> Date .. <br /> +aSx�.aslas�sC�oa� fo/ao) <br />