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-ROf1 :CALIFORNIA WPTE? SERVICE FAX NO. :2094640195 Apr. 30 2010 10:480M P 2 <br /> APPLICATION FOR WCR.OACM=T PERMIT <br /> PEASE Pam: U V a W <br /> Date zo. l C7 OFF3:c$ VS2 01my <br /> TO: San Joagl in County JOB REB # <br /> Department of Public Works APS Cyr # <br /> M. DA <br /> 1���CSR�v1 P� t � <br /> SEF vnzn ruvs <br /> � Axs: <br /> r4plicant xame) STRM A — <br /> AM <br /> (Eta LU—ng addroBs} Fom _Z <br /> NOTE i <br /> (City, Stato, .zip code) <br /> C +T%R ` 'Ab'Ui _ �0 <br /> (Area Code - Telephone Number), <br /> Sketch, (/Detailed plans may be silbLtted) <br /> Me =dersi.gmed hereby,applies for permission to,exa,avate,, ngt=Ct and/or <br /> otherwise-encroach•on -County•Highway 4srht-of-Wayl.oa•the side;,a <br /> Gj� approximately ee /mile <br /> Il- <br /> Of '' by:perfo=ing the <br /> fo110 g r (aescriptiOu Of,work) PA »� <br /> J . <br /> Work will co=ence A or'about fo <br /> gays. r appxoxintatel <br /> , <br /> ;, the undersigned certify, that I am the owner' Of the. 'respective propextyr, or am <br /> qualified to represent the owner and agree to•do the ork described,abova in <br /> accordance with the rules, regulatioas'of San �roat�x: County and subjtrct to <br /> inspection and approwaJ,, �� O O� <br /> Sis=ature of t j <br /> App13,Cant � rifle 1aa�e <br />