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12007 14:35 �O0 68B324 SJUJ PhW1Ib • rra�t oiin� <br /> APPLICATION FOR ENCROACt PM..2MTT <br /> arm A RRIN2e -7 <br /> xc: San.Joagain county JOS # # <br /> Dspartment of Public Works APN CR' ' # <br /> EXP. DATB <br /> GW '�'1 X'CO A' NA-A-500) VALID. —M D&=PSW,i B1 <br /> (Applicant Name) sTRae aiN Aocy �, <br /> ARBA pvAD F S <br /> Wailing( Addreao) FORMS. <br /> C H,rRwTrLr . <br /> (City, state, -ZAP code) - --- <br /> C"700 7?) - e <br /> (Areca Cede Telephone.Number).. <br /> Sketch- (Dete.ilad plana may be <br /> ",'a"t;©✓6.Jn._c, e�'JS+`+OcI��t.cvt` wbeaubAitted) <br /> "d 10-- <br /> ` C3✓_6O� �e.7k/2c �wd <br /> S J.7rtID6 iScA•b-b-_cLe� tan'C(ol 51a �c <br /> Ary rcwi11 �y \ + cotIl. <br /> Eob•l <br /> The uadersigned hereby applies for. permias,ion to.exbavaee, construct and/or <br /> otherwise-am roanh on-CouaGy8iglsway Right-of-Wayoathe . FA,S�.•- .'•' gidC'..of.,... .- . . <br /> So;�L 5i-cl�lr approximately 6030' fee /mike ,AIorLL- <br /> nf cs6 ,J s �/ , ,. , , by;iei•Formislg the <br /> following work (ileac ption o£: -L� <br /> work) : . <br /> ) <br /> JAg. <br /> work will commence on or'about a for approximately <br /> days• . (a <br /> "r , <br /> I',: the ,undersigned cn_rtify, that I am the. PkWner o£;the res iective property, or -am <br /> ,qualified to represent-the owner wa agree to. do .the Woxk descri'hed above in . <br /> accordance with the rules, regulatione 'o£ San Joaqu2ti Cdunty. and subject to <br /> ins <br /> p <br /> ection <br /> and approval. <br /> -b, <br /> fe.LTuJ'R. NYIQCAiTKFNt.. . C 3e7 Cl <br /> signature of-Applicant Title Dante ' <br /> MMrM1>1.P8\l��a7L Ic/ool <br /> 1 <br /> J1W-P7-PRR7 OP:PRPM FRX:20946R9324 ID:MWH PRGE:001 R=96% <br />