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``j:�j,`� '%•`' -a s�jLL Y,'�`.:i' _ `4 <br /> (`"=�j+.,'1(:i"•i'y- `i` iT <br /> kQ >Z 9n Q-0 1 I <br /> I <br /> i <br /> Departmant of Wil;c works /J LP' Lt i <br /> RAppli oant Name) S ti_KAT �l6!// / /.IV _ <br /> EEO .Ci-WR-1 M,\ lr\ITYPE l <br /> ? reg Address) FORMS � Av Z <br /> �, • g� _ O <br /> TE <br /> .Zxa l._od®) <br /> (Area Code - Telephone number). <br /> Sketch (Detailed plans may be submitted) <br /> The *:ndersigned hereby applias for perMalssion to.Q---&ava`e, construct 'A-d/or <br /> oche_ ise-encroach•oxo County Highway Right-as--Nzyoa the <br /> C� rl�i u i YtQ � approximately }� r-�e_ /mile <br /> of Q cLr by -per•€oxzvsi6 the <br /> following work (description of:work) : <br /> Lccn <br /> Lq <br /> Work will commence on or'about ' 5for approximately <br /> (D C� <br /> days. <br /> I, the Undersigned certify. that I am the owner' of, the respective-property, or am <br /> qualified ified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulatioxas 'of San Joa-Clam C6unty and subj eat to <br /> inspection and approval <br /> N�ek M0-Cc)nr\-tt� <br /> A a i_LE N — <br /> Sigr_ature of Applicant Title Date <br /> R�S�.PS`PE:xSmL (5/00) , <br /> F <br />