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FROM :CALIFORNIA WATER SERUICE FAX NO. :2094640195 Aug. 21 2006 10:46AM P 4 <br /> Ap)?L3:CATION roR MCROACM&M PERMIT <br /> pLEAS� PR�t3T� �"�C��. _ • <br /> Date <br /> OP71C'Si USE OMT <br /> TO: San k7oaquin Co=t,y SOB el;—;X 77 REQ' # <br /> Department of Public Warks APN Cit # <br /> MM,, DATB I •I'� <br /> VALM !E-Zr, TO • DRI�S"iCA'�s: <br /> {Applicant Name) STSGRser'Aj* <br /> ,�y,1 AREA� T�tkW Qmm <br /> (Mailing Ad&U Daa) Pow" �' 'l <br /> NOTE <br /> (city,�State, .zip Code) <br /> c�. s ' IAVA w%IS�, <br /> (Area Code - 'telephone Vvmber), <br /> Sketch (Detailed plazas may be submitted) <br /> TLe undersigned hereby.applies far permission to.excavate, construct and/ox <br /> otherwise-encroach•on •County=•Highway R '(ight-of- W..0n-Pe •Vy,VUST <br /> klsx_�Vw_ 41�mi!e ' <br /> 'Of d`U w RY '• , by 'Performing the <br /> following work (description of;wor)c) : <br /> 7 ''BALs'- .8`, y xyly_ 'V KU\11F__, <br /> Work will commence on or'about CQ "cis for approximately <br /> l�b days, <br /> _, the uadexazgned certify, that Y am the ovner' of•the respective -property, or am <br /> qualified to represent the o=er anal,'agree to do the work described above in , <br /> accordance with the rules, xegul.ati qns'of San 7oaVt n Cp6=ty and o-ubj ect to <br /> inspection and <br /> Signatuze of Applicant Title Date <br /> 191tS"aK.?i1�'Si�2. (6/oat - . . ''•� . <br /> I <br />