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FROM :CALIFORNIA WATER SERUICE FAX N0. :2094640195 Sep. 02 2008 02:22PM P 4 <br /> APPLIhTION FOR MCROACMMT PIERMYT <br /> Date - �• ' 0$ OPME USE ONLY <br /> Ta• San Joaquin county aos # 3oo?'? REF # <br /> Aepartment of Public Works AM CR # <br /> �1..` ► <br /> M. DAVE df•1 S•08 <br /> VALM f2.08' TO !t-is•08 MrMKYS: <br /> .(Applicant: game) STREET 1MYgAi-i 'AVE <br /> TYPE HOLA- <br /> (Naill=g Address) FORMS — <br /> SC�.i�©'h Nom ' <br /> , <br /> (City, state, •Zip Code) <br /> (Area Code - Telephone Number), <br /> Sketch (Detailed plarav may be submitted) <br /> pr • <br /> 2 c v <br /> The undersigned hereby applies for permission, to.ex Yate, construct and/or <br /> otherwise-encroach,on •County Eigbway Right-of-war•on the <br /> of <br /> approximately 22C a C/mile r 4L <br /> .�� Ain. - <br /> following work f descwork) :' r perfoxraiz�g the <br /> riptti.oz� of, <br /> Work will commence on or'about .o for approximately <br /> da�rs. . <br /> 2, the undersigned Certify that I am the owner' of',the respective ,property, or am <br /> qualified to represent the owner a d- agree to do the work described above in <br /> accordance with the rules, xegslations'of San Joaqu�n County and subject to <br /> inspection and approval. <br /> Signature of 4plicant <br /> Title bate _ <br /> �►s .a�\n�ccr. (6100) ` <br />