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FROM :CALIFORNIA WATER SEROIC.E FAX NO. :2094540195 Jul. 25 2007 11:58AM P 2 <br /> APPLTCA'T'XON FOR $NCROACMNT PMUaT <br /> DatOVVI R USE ONLY <br /> TO: San Joaqu ounty a0H # d 77 REF # <br /> Department of public Works APN CE # <br /> W. DATA 7 <br /> A^C 5 1l vzL3ll TO —zi-7-4f. DCLrMAYS: <br /> (.Applicant Name) 8T "Al <br /> TYPE <br /> (MailingpAddraAs) r� ro" �y <br /> NOTE <br /> (Ci.ty, State, -Up Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed P'IMS may be submitted) <br /> The Undersigned hereby,applies for Permission to.excavate, construct and/or <br /> ot7aerwrise-encroach•on, CoumtY•Sighway 94ght-o£-VJa ••on•the "V/L�'�'• <br /> approximately 1 ee / #3:g4'LTC't� <br /> o <br /> by'Porformiag the <br /> following work (description of Work) : -� <br /> Work will commence on. or'about for approximately <br /> l -- days• <br /> x, the undersigned certify that I am the owner of the re$peet:We property, or am <br /> quaxiEied to xepaceseut the awnex axad ,agree to do the I;ork deseri)bed above in <br /> accorcUnce with the =lea, regulati of San Joaga�n County axad subject to <br /> jinspeation and approval.L4ci"c'M-,Q <br /> si tura o£ I^ i�� .. <br /> 9 App ant Tit3.e nate <br /> Iu�8sm1.AS\ARRM= (F/a41 <br />