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FROM :CALIFORNIA WATER SEPUICE FAX NO. :2094640195 Apr. 24 200E 02:20PM P 4 <br /> APPLICATION FOR EXCROACMONT PSMIT <br /> • Q -tet <br /> Data \ � . a a.� 0mcs >78a - - <br /> TO: S= Joaquin County Nola # 7 3 0, 7 Rw # . <br /> ca '#17epartment of public WrksATCRUTOWN' Vq R- �R � 1M1 {�r 2 - <br /> J2ODRIV'MWIVs <br /> (X►pp3l,l.ca nt xaaaae) STT T c3 + <br /> 15a4�r1 • �Mot�iC1c� <br /> $ srJc�,10 Qm►D c <br /> � <br /> (mailing address) vow _-V <br /> , �!.� L, <br /> (city, state, -zip code) <br /> ave- �-1So�1 311 <br /> (Area Code - Pelephone XT60 ). <br /> Sketch (Detailed plans may be submitted) , <br /> .51..EWp <br /> 'K7 T Rc..'t 7tm <br /> The anile signed hereby applies for permission to.excavate, conatrwt and/or <br /> otharaviaae•ea=oach.on Cony.>cighway )bright—of-Way-on-the %Mr- • • bide,;,o>E •,• - . • <br /> _ A, approxi mately j k Q1 uQe NN .= <br /> of IF L1lV AVE, .4. 1 bYNpewforing the <br /> following work (description of work) <br /> hRC��N,''hLE A1K. <br /> \ LCL. .0b' X L1' ' \A_ <br /> aA <br /> Work will commerce on or'about for approximately <br /> 100 dayo. <br /> 1, the uadersigned certify that x am the owner of the respective property, or am <br /> qualified to represent the owner azd wse to do the viork describe d above in <br /> accordance with the ru7 , regulatiaa 'of San Joaquin County and subject to <br /> i.nspectioa and approvaa].��O tio`az ' <br /> Signature of Applicant - Title - Date <br />