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_z_•.!::`I r,1.=.F���_�__._��:�y 4l'...�.. 5:.`i'41':.' FC`F:`i l';i:.,S..-. .!�:-.�_•p`�..�'1'1= <br /> •�o Baa 9D`q V_'L', eC) 2 an t � !on <br /> 3V-V?&Fse <br /> ( pp <br /> ice=- mssme) <br /> (moi'S sg �ddrass} rQ��S S5 1.U' <br /> (City, Sbate, .Zip Code) <br /> Mrea Code Talat hor_-e.RunibEr) <br /> SkEtch, .(33i_-tailed plana may be sbbmitted) <br /> The undersigned hereby applies for permission to,excavate-, don trzct 'aid/or <br /> othe_ ise-encrrac��•oa Wi t •Hig Way Right.-os-'x y•o a fide.. <br /> aaprari tely $eet/�i�e. <br /> of t s by.l}erfo I-ACT the <br /> olli o g �+sork (descr3pti ca.of:work).: <br /> L 3 <br /> Work will commence on or'about ���� �c,1c�e� �� 'ao 1 -ID— for approximately <br /> — Q � •, days. �Jc'-� ��� ��- `�7.��• <br /> I, the undersigaed certify. that I am the of-?er' of,the xespective -Property, .or am <br /> qua- ;lied to represent the owner and* agree to do` the W*ork descried above in <br /> accordance with the z, es, regulations'of Sas aoaquis County and subject; to <br /> inspection and approval <br /> 1{� .3 I <br /> Sigr_attsre Of A-V licant °tic a ata <br /> I6/DD7 - - - _ •.• - ••.` <br />