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FROM :C-ALIFORHIA WATER SEIROICE-E FAX NO. :2094640195 Aw;. 14 2001 J':Fl4P[-1 P 4 <br /> AVPL3:hT3:0IT FOR MCROACMMU MWIT <br /> Date OFFICH USE ony <br /> To: San JOaqUin County COB # -7' <br /> Department of Public Works APN CEr #_ - ' <br /> M. D&TS Alilrl-07 <br /> T6 DRIVEWAYS <br /> (Applicant Name) T IRM <br /> TYPE 1,4— <br /> (Hailing Addrdan) FORMS <br /> -Sk_QKWUW\ 4z�s ao ts NOTE <br /> (CitY, State, -Zip Coda) <br /> (Area Code Zelephone M=ber), <br /> Sketch (Detailed ilans''May be Buimitted) <br /> Axp A qk�4rkk <br /> The undwsigned hereby.applies for perMiSsion to.excavate, st t and/or <br /> othor. ach�on County.Mighway F7ight-of-Waygon the <br /> .* - Q-_%AA approximtely ee Mile <br /> 0 1- <br /> f Al _n'_ 'perfozmiAg the <br /> ll,owipg wQrk (desc .1tiolpt of wo <br /> V <br /> AllfKA, _xIr <br /> work will commence on or,about for approximately <br /> 1, the uadersigaed certify that i am the owner of the respective property, or am <br /> quaaified to represent the Owner and agree to �b the i4iork described 4)Ove in <br /> accordance with the rules, reg'alatioxxs'of Sau .Toaqu�n Co=ty =d 31!bj�ct to <br /> inspection and approv,-a. <br /> siq=t6de of Applic=t TFitle Date <br />