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*<-' M :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Jan. 04 2004 09:05PM P 2 <br /> APPLICATION FOR 3K(.R0A ' BERUT <br /> Date OPPICS vss ONLY <br /> JOB <br /> To: San Joaquin County CIK # <br /> Department: of public Works ApN <br /> W. DAT /0 30 CS• <br /> VAL11> 6 Z x TO /o v np.rMnY9: <br /> (ApplLcau t XAMO) STUST AM 57;x#rWj <br /> * - <br /> (Mailing address) FORMS � ..ss/_VjW 0,eLgIr <br /> (City, Stater -UP code) <br /> (Area code - Telephone mer) <br /> Sketch (Detailed �1aas may be submitted) <br /> The undersigned hereby,applies for permissi0%X to,excavate, cons rt}et and/or <br /> of e•encroac •on coumby Sighway Fight-of-W&y.•ott•the V1 sidd.b <br /> approximately ee <br /> of , ^, ` <br /> by'Vexforming the -:F <br /> following work (description of work) a t r <br /> wox will commence on or,about for approximately <br /> LO days. <br /> I, the undersigAed certify that I am the owner, of tba respective property, or ata <br /> qualified to represent the owner and agree to do the raork described above in , <br /> accordance With the rul , regulatiana'of saxx Joaqu a county and Subject to <br /> inspection and approval \Q-aksz Q1�s <br /> SignatuxB of Applicant - itle Date <br /> wuasa,.Ps1/acot� ii/Dol .. . . . . <br /> I . <br />