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APPLICATION FOR E9CROAC ENT PERMIT <br /> l� ,EASE .PRINT, <br /> rJ OFFICE un-MMY <br /> Date <br /> To: San Coaquizi County aw # � vS{ `� REE _ <br /> Department of Publics Works APN _._ -- . _ -- CR " <br /> VE l?(Z O VALID 2-2_f-08 TCY {"C�c3 73RT iTE97A7Cs <br /> (Appll cstmt ire) STREET y%AM►eW 1 U_k_ 2>.. <br /> TYPE <br /> (Mai.ii:ng adldx®se) FOR�rs. � /•v,�. 7- <br /> NoT'R <br /> IVANTEL-A _9,.T3.36 <br /> (City, Sbate, .zip Code) <br /> Zoe - 239 - 03fB <br /> (A.sem Code - Telephone ifunbex) <br /> Sketch (Retailed plazas may be submitted) <br /> 1:75 1 <br /> utidersig sod hereby applies for perini.seion to;excavate, =ztXuat and/cfr . .- <br /> o he ire cxo�,ch oP••Cotanty•Highway Right-of-W& ••oa-the �f�•S <br /> A � i _ ,�: ..�, r � : ;�. �. <br /> --- approximately i anile _/.1j <br /> of G l -: 'E�', r 0 : r b1r pexfiozming the <br /> following work (description of. work) ShD,v " <br /> Work will commence on or about for approximately <br /> 6 D Sys. <br /> 1, the undersigned certify. that T am the owner of, the respective property, or am <br /> qual.i,fled to represei1t the owner and agree to do the woek descrilmd above in <br /> acaoxdarace with the rules, regLil.atiozs 'of San Joaquin county and subj act to <br /> inspection and appro,re,1. <br /> Si.grMt=e of Applicant - Title Date <br /> _. <br /> MA9h'iCR,P9�UB5A� f6/00� . <br />