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UJ/LU/LUUD 14:OL NAA IOU U4L OLUO llUllLri & AaaUILAAIL3 WJUUG/UUo <br /> 03/20/2006 14:33 2094689324 SJCO PERMITS PAGE 02/03 <br /> APPLTC TXCN FOR ENCROAMUMM' PBR=T <br /> Date —�T�6 o cat Von 0my <br /> To. San aoaq xin county toe #) � REP # <br /> Department of Rxblic Works <br /> Exp. HATS -o <br /> VAL= TOD!lIV�AZB: <br /> f (AJJpplits int Name) ST"BT t <br /> 4b_ 9 __T k.rd ST'.ro TYPE U=L <br /> (MailiUg adgdream) FORMS. -7q' <br /> �L%,L M 1 f�iT� i�A- OTS' .. <br /> (City. s ate, zip cage) <br /> ("R Code - Telephone fiber) <br /> Sketcft (Ddtailed plaice reLy be submitted) <br /> ar. 1ltNlti S�de•7� -1 2 <br /> 9► b rs n u p.7 is 4 <br /> 0 <br /> CD Cz- <br /> The =deratgaed here]yr applies for pert%iasiou to.wxcavate t congtcruct aro/oig <br /> othe�ewi.rse• aiaaala om••Cotmuygighway Right-of-Way-.02,1-tthe �,£•-; <br /> A- <br /> 16C approximately ;�O <br /> air <br /> by,-001-so the <br /> following work (description of work) : ?� <br /> a . �r <br /> Nork will commence on or'abott Z for approximately <br /> �-- days. <br /> 1, the undersigned dertit that .l am the owner of the rmepeetive -property, •or am <br /> quali tied to repreeent the owner and, ag"e to do ,t he vrork demo Abed above is <br /> aceorde ce with the rules, regul.at:iozza'of San Jo&qudm'Cbuuty and o bJ act to <br /> i-nspection and approval. <br /> Si.ganture of Atippl.i,caut: - Title yT pate <br /> Haure2..Pn�rasocaur. (s/oo1 � . <br /> h <br /> . it <br />