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-U +o•=wJ1Z= _idyl. 11 �L'1!'_ :jSPM P <br /> APPLICATION POR LNCROACMMNT PERMIT <br /> PLEASE PRINT <br /> . n - <br /> Date 41 OsgaCO USE OwjY <br /> To: San. JOaquim COI=tY aon # '�30C3'��t REF <br /> Depaxtmexit of Public Works APN <br /> \JbE t �,. �7 .1��, <br /> VALID- it' i 1 '�Tp �3 15 i t DR$4MYS: <br /> {Applicont sme) STREET El 4, T. +x <br /> 15b VA. \CEJ TYPE BELL <br /> ' 5rc�x �J ¢SAD s <br /> (Halling Xddreas) FORMS -s-'Aw w1) jz.27 , y <br /> NOTE <br /> (city, state, .zip code) S)S �t�RGE,(��c y t?EPr4 <br /> (Area Code TeY 3xaae N=bex) <br /> Sketoh (Detailed plans may be siubmittedy <br /> TLze undersigned hereby appbieS for •parmiS8J(= to.excavate, construct and/or <br /> otherwise-enc oach•on •CouatY.-Highway RightIR -of-ways on the <br /> •de:.of�.. <br /> o f �� ;+-.-. appxOximately � fee /Ache + . <br /> £off low.ng work (descri�tiaa ow;work} �• � , h'Y'PeYfosnux19 the <br /> _ <br /> Work Wa 1'1 commence on Ox'$bout _�'/•���1/^.\1Wlj 1Y <br /> days for approz matply <br /> I, the under.signed cex•rify that z am the ownex' of•the respective property, or am <br /> accordance qualified to with <br /> thsent the owowneraacf ajree to do the work descxabed abaccordance witJ� the sent <br /> x ati ='of Saiz Coavim County and subject to <br /> inspection and app:.•ova:'.. �t <br /> Sxgnit=e of xpplict <br /> • Dante ' <br />