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lt'* U11 =i,:AH F hum' P.2 <br /> 1 nLrL V L/ C..'t <br /> APPLICATION FOR WCR0ACMMNT PI MIT <br /> „���EASL PR NT: <br /> late ` �.U (� orFxc1h: ass ONLY <br /> 3 <br /> TO! San ,?aaquir_ County JOB <br /> Department PabliC W0:-k-3 CR <br /> 1l }.� r <br /> �11�1 S �1� � _ _— i VA s ZD TO -?-24r. DkIVEWAYS <br /> {AAAI i c t Name) S Pi2E T <br /> ;REAIL <br /> 2 i C fit, sc ,.-.. <br /> tMailing Address) d4R'�S <br /> .3 I <br /> (city, stats, Zip Codo) <br /> (Arad Codd - Telephone Number) <br /> Sketch ;Detailed p a1na may be qubmctted) <br /> i <br /> i <br /> jfj� B <br /> 1 t <br /> f <br /> rfr <br /> 9 <br /> The undezaigned herel-y applier 'fo:r p�.rmjcoion to excavate co-Istruct and/or <br /> otherwi.ae nneroach on Cou7YCy lligaway *cigk:t�tsf-a'Ety cs i the gide of <br /> -_ -- ap;n=imatel} _ feet <br /> Of7== ... , �Y'ger€ostninc tele <br /> following worn (descrinti.on•-<-i fork) ; <br /> C•1_-( a__,S ,2t� N �21D [ t ? r 2c?�� _ om <br /> work will aOmmence �-' o- ab :• " fit, ZU t. 1 '="°' approxi.matesy <br /> days. <br /> the undersigned certify -,hat z am ta-, owner re propa-,t, or s.-,j <br /> qualified to represe--: the owner and agree ',c 'lu chs work described above i- <br /> accardance w_-,h tna ru_e0, _-ecu'.atiors c:f San County and auh�ecS -- <br /> Wnapectio. er.d approval. <br /> paink COMM-k*t. <br /> 5«g{zatura of Apm1l7,a.nt �"'D Lln —Date <br />