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FRO[I :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Feb. 83 2004 0.3:10PM P 2 <br /> APPLI&Azcou FQR F.NCF.0ACMMXT PERMIT <br /> PLEASZ PRINT; <br /> DaG6 OFFICN C7•SE ONLY <br /> To: San Joaquin County JOB <br /> Department: of Public Works AQN C <br /> t VA7,lI} J,ZZ(o'c2 TO ._ `eyDRSVBWAYS x <br /> (Applicant Namo) STREET S43 LY>U1 &)E ZV <br /> AREA Seo <br /> ----— TYPE 6G f/v <br /> Nailing Address} FORMS <br /> Socio , t; :Q <br /> NOT-2 <br /> (City, Strata, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketclx (Detailed plans may be sul mi.tted) <br /> The uudt*rsigned hereby,applies for permissioxx to,excavate, construct and/or <br /> otherwise-exxcroach•on County Eligbway Right-of-gay_oa.the <br /> 'SNU G 1a 1 C`C T a i h1 t approximately Q I <br /> r r , by performing the <br /> followizig work y(descri t.10a of work) ; <br /> Work will commence on or•abou* <br /> days. d for approximately <br /> -t, the Uadersigned certify that X am the owner.of Che respective property, or <br /> qualified to represent the owner and agree to do the work described above in am <br /> accordance with the rules, regulations'of SM Joa <br /> inspectio-a and approval. <br /> Com•.4b-b$ n County and sub jeGt Ca <br /> si 9=tura of Applicant - Tttle <br /> Fate <br /> +aYx1GL.P4\DIt25�riG (6/405 ' <br /> ' f <br />