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FROM ::CALIFORNIA WATER SIICE FAX NO. :2094640195 Cep. 26 2008 02:27PM P 2 <br /> A�FLICAT10K F01Z ENCROAC M PEPIT <br /> ,PLFME +RINT• <br /> Date �•-�� ► •1 CkJUap 4� { <br /> oj,rpzcg 17SE ONLY <br /> TO: San Joaquin County 1,70B <br /> Department of Public Works REQ" $ <br /> \ECS Exp. DAT' I -i _U <br /> o-�TO <br /> �� <br /> ' {App3•icant Name) vALIa Id-- ", <br /> `� 5CC o� QUAD <br /> (Mair •-- T�PB l � --.,.•'_ W •�— <br /> 9r Address) FORMS <br /> NOTE <br /> (city, State, .zip Code) <br /> cK1ZR ' 'A6'A <br /> (Area Code - TeJQPhono Number), <br /> Sketd� (Detailed ply may be sUbm3.tted) <br /> The undersig' ed hereby applies for <br /> otherwise-encroach•on Co=t .. 8 40n to.excavate, c0astruct and/or <br /> y Highway Wight-Of-Wayt.ou.the <br /> • <br /> Of AVS• aPPraximatelyside,--..�.�....�-.-• <br /> 7 f0110 in work (descr {� by'Pexfbrminponof,work) . <br /> the <br /> X <br /> 'Work will commence on or'about Qq. <br /> laQ days. :dor approximatel' <br /> 2, the unddrsigned certify t)ia� Y am,the owner' of,t. a respective ro ert <br /> �Xified to repxesexit the owner agree to do v P P y. or am <br /> accordsaae with 'the ru,e r the work desc.,xbed above 3u <br /> a..aspectiaa and approval. � `egulati of San �ToaVin County 8=,d subject to <br /> S�gaaturo Of PPlicant, Zitle � 1 vas <br /> Date <br /> • I <br />