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_. — - --- - -. ._ ..�_ tn°. _. c:J 7ib•-4J17 v 1Jr_v=. Cl :=✓J1J kJG•t'yF'I'I h' G <br /> APPLICATION FOR EUCROACBaMT PERMIT <br /> PLEASE pRINT <br /> Date - <br /> a{.O Q OFFICE U'sX ONLY <br /> To: San Joagaiu count r JOB 730 Z <br /> Departme-it of public works REP � <br /> APN _w C.'E,�',' <br /> {App3icrsxxt Name) oft.— <br /> $,� .... nxx+va' �s: <br /> ! � !. ► T $ K e- .. ....: <br /> NOTE <br /> (C3t-Y,'state, .zip Cod®} <br /> (Area Code - Tej pz one Number). <br /> Sketc}a {Detailed 7ilar3s may be siabmitted) <br /> i n7 <br /> 'he tinciexsigned hereby applies for pexxiss3oa to.exravate, construct and/or <br /> of se-encroach•on• 4COUx ty•aighway Ri h �of <br /> • approximately �y�o•A•the Oy"k•�• - 9�•icle;,a�g,... - <br /> of ee /mile <br /> '£' <br /> following Mork (description. of;work) s • ex:E'oxraiAg the <br /> Work will commence on ox'about <br /> ton days for approximtely <br /> », the Utz to re re certify. thet I am the owner' Of,the respective -property' or am <br /> �ua�.if�ed to represent the owner and'agree to do the +nark described above 3n <br /> accordance with the 'razes, Z99A. t �'of San x7oa <br /> inspection and approva?,. �a� � County and subject to ' <br /> nr <br /> S:.gnatsre of Applicant 4- T ae /34nli <br /> - la:xt <br />