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FROM :CALIFORNIA WATER SERUICE FAX NO. :2094640195 Mar. 29 2007 12:OOPM P 2 <br /> APPLICATION FOR EWCROACMMT PEIT <br /> Date ovrxcz USE ONLY <br /> To: San. Joaquin County c70B # 73� <br /> Department of Public Works am <br /> [� ��11p�1t Tr tQ�r ES.p. nATR <br /> '7-1,0 7 <br /> VALID 4-12-67 , TO X07 DRSV=AYS a <br /> -., (Appli eant Namd) S'TPMT 1511 0 LJ * _ <br /> AM 57" 1111AD - <br /> (ai•liAl Address) FORMS �Gy�� <br /> IZZ 3 NOTE <br /> -(City, '9tate, .rip Code) <br /> WA- 'AVA-2311 <br /> (Axes Code - Telephone Number), <br /> Sketch (DetaAled pians •may be eubmi.tted) <br /> The undersigned hereby applies for permi.Ssion to.excavate, COUStract and/or <br /> otherwise-encroach-on county.Highway fight-of-Wayoa-the 9i '..'0 <br /> C1 ' spplOximately �� t ee <br /> of , • ' by�?aVeo=iAg the <br /> followinstark (descript on of work) : <br /> 1'O <br /> work will commence on or-about for approximately <br /> days. ' <br /> x, the underaignecl certify tbat x am the owner of the respective PrOPerty, or am <br /> qualified to represent the owner and agree to do the work descriled above in , <br /> accordance with the rul , regulati,on�s'of Saga Yoaqu�n County and subject to <br /> inspection and approval <br /> Siq=ture of Applican - Title Date <br />