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FRnM :CAL I FORf•d I A WATER SERO I CE FAX h40. :20946401'35 Jul. 21 2008 02:,1 RM R 2 <br /> A PI-NATION FOR FN•CROAMENT PERMIT <br /> PLLA E PRINT <br /> Date ~ L1LY Its. .�C�� OFF101 USX OMY <br /> To! San Joaquin County JOB REF # <br /> Department of public Works APN CR # <br /> EXP. DAT9 iO — 0 <br /> VAT ID. TO , ,J Q-i . DRIVBWAYS: <br /> (Applicant Same) S'T'REET ADBGf�,2f� � <br /> `�6 �A AM <br /> �lo�kzon/Qt �S <br /> � � x`�• �1`�\��� TYPE o� <br /> (Mailing Address) FORMS <br /> ©�.LI;Z . - M NOTE <br /> (City, .Stater -Zip Code) ' <br /> (Area Code - Telephone Number), <br /> Sketch (Detailed plans may be submitted) <br /> 151t� %NIP <br /> The undersigned hereby,applies for permission to,excavate, construct axed/or <br /> otherwive•-encroach•on, •County•Highway Right-of-W&yos•the •NNY4~;. s'ide,.af- ' <br /> t�r1F.CbF 'C` A��1;� approximately 3 f e t3►e 1C _ -- <br /> Of _ LT'l by'performing the <br /> following work (description of.work) , <br /> so <br /> • u►1�13'�_ �� SC' C?�V"R�E1.13'��C~ i1UE. � "�[la 1 C�dC� <br /> Work will commence on or'about _�"1 ~lla- C�Qt for approximately <br /> says. y <br /> 1, the undersigned certify that X am the owlnpx of.the respective property, or am <br /> qualified to represent the owner ana agree to do the vi'or'k described above in <br /> accordance with the xule , regial do of San Jaac u t� Couaty and subject to <br /> inspection and approval,��Q` 1b �qS '' ' <br /> Signature of Applicazt Tit2a -- Date <br /> Mr�t.Ys\r�sc�. i6/ao7 <br />