Laserfiche WebLink
FRO!'1 :CALIFORNIA WATER SE=RV I CE FAX NO. :209464019t) <br /> J u 1. 12 2UU i' 11:4rHl''I r 4 <br /> APPLIMTxON FOR F.NMO.&CA=T p==,r <br /> Rate { OFFICS USE ONLY <br /> To: Saa as ty 'TOB 730'7'7 REF <br /> Department of�Public Warks �j APR <br /> RT � IER <br /> lf <br /> VALZO 01 TO '7:F-01.. nRxV�fRA7CS: <br /> (applicant Name) STREgx` M6rri + <br /> AREX <br /> TYPZU How <br /> (Mailing Addraw FORMS 5 u►w, ,�2Y �' -- <br /> SC ` .b1 NOS <br /> (City, Sbate, .xip Cods) <br /> (,Dares, Code xelayh=e Xtt&er). <br /> sketch (Detailed be submittad) <br /> The undersigned hereby applies for permission'to.excavate, C4II8tt1,�C� and/pr <br /> otherwise•encroach.oa Cou b ffi.gXxw a R;i ht-of- y. <br /> ht C•1.l 1 L Y g Wa •the " ASC`' „ K <br /> of SA \�.-S4l�i 1 , aPPraximate�,y — AIWS 1 ee �id�•.�of <br /> WA! S4UTK <br /> f"?\k k descri tion of Work gexfo=dAg the <br /> 4 <br /> Work �w13.1 cottYi ence on 0r.S17ut <br /> +. .) dy$., fax appxoacmaGeZy <br /> x, the uz}.dexsigned certify that z am the owner, of the respective prapert3r, or am <br /> qualified to represent the owner and agree to do the work described above �a <br /> inspecancetion with the rul r aC ns'of San Joaquin county and subject to <br /> inspection axtd approval� � . <br /> sisoature of gpp�ic (t�_ r4 V <br /> Data <br /> ��•� L (6/00} <br />