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PROF _ALTFORI1 r !,jP.!—f' _GR __C c l F l --- rr 0 <br /> APPLICATION FOR ENCROACESNT PERMIT <br /> PLiASE R 2JT t J <br /> a �o <br /> Date OFY+xCE USE ONLY <br /> To: San Zoaq in County YOB ��3X 77 <br /> Aepartmeat of Public: Works <br /> VALID. 7 D To 6 DRT'PE60'AYS: <br /> {Applicant Name) SST <br /> ARS7� !� 1SY�✓ QUAD � -- <br /> 15f� <br /> (Mailing FORMS <br /> NOTE <br /> (city, Stato' .Z p Code) <br /> (Area code - Telephone X=ber) <br /> Sketch (Retailed playas may be submitted) <br /> The Undersigned hereby applies for permission to.exra�vate, cons;x`tzct and/ox <br /> Otherwise-encroach.-on county..�.ighway Right •vat St <br /> o£ approximtely () fee- /mile gQLLO:•of ' <br /> I' lowing ork (elescri tion of,Work) by Verfo=dng the <br /> Work will co ce on or est t + <br /> —� 2Q days. £ar approximatel, <br /> •l, the unciexsig-Aed cert ify tit 2 LT the owner' of,the zespective•property, or art <br /> q:al.ified to represent the o=er andagree to do thework described shave 3n <br /> acccirdazcce wztlz e ztztes, a ions:of Sass. I7oagu-ins County and subject to <br /> inspection and approvaj. <br /> • <br /> gig�tsture of .Appl3castt •� Ti le . <br /> • to <br />