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OM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Jan. 06 2004 06:26PM P 2 <br /> APPrACATION POR ENCROAC "M1111 <br /> Date <br /> aFaxCs V93 ONLY <br /> TO: San Joaquin County `OB # o V' R8F # <br /> Department of public Works <br /> APN ' # <br /> pp j Q Q / EXP. DAT$ <br /> Sl?\\ % VALT.I> 81dLV TO -4Ao , DRZVBMAYS: <br /> (Applicant Mame) STREE'Z` . Pec .v° aw-6- -- * .�._....... <br /> tv+y[/�] \}�/ \hV�\ aj�\ (�Y�t ARFA STo�Acrdw., QUAD CC-�� # <br /> Tyrz 9. <br /> (bailing Address) FORMS - <br /> Soc�4�.ota C� `�&0 3 <br /> NOTE <br /> (Citta, St&te, .zJp code) <br /> &act- 'Ab'A-8311 <br /> (Area: Code - Telephone i umber), <br /> Sketch (Detailed plans may bs submitted) <br /> The undersigned hereby.applies for permission to.excavate, construct and/or <br /> otherwise,encroach•on counbys•Highway 4ghb•of-wayont the -_ 'aids.. f <br /> approximately � e mdrl� L4 LL <br /> of _SJ�Q' ; . ', .• , by vevformiug the <br /> foil wing wozk (description of waxk) <br /> Work will commence on or•about for approximately <br /> days. ' <br /> r, the undersigned certify that x am the owner of the respective property, or am <br /> qualified to repxeaent the owner AAd agree to do the wioxk described above in , <br /> accordance with tlse :r 1 , reg'ula ions'of San �oaqus n County and subject to <br /> inspection and approvalv0"&A^C� <br /> ., ~ <br /> CIS <br /> Ons <br /> Signature of Appliaant: - Title Date <br />