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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Oct. 10 2008 04:12PM P 6 <br /> j'1PPX,1C"AT10N POP, WCROACMMqT PER=T <br /> 'UM PRINT: Q <br /> Date Q`..i•+ 0� � 1 <br /> OFFICR USE ONLY <br /> To. San Joaquin County JOB $ 1,06 77 # <br /> Department of Public Works CIC , # <br /> CSR�1� ��s� SSR EXP. �A� !Z•!,S•08 <br /> �1 VAT�ID TO l2•r5'•o8 nPAVMYs; <br /> {Applicant Name) STRUT _ S'7- <br /> QUAD <br /> � <br /> - TYVi o� <br /> Mailing Addr@ss) FORMS <br /> NOTE <br /> (; City,�Sptrat(oer�zip Codo) <br /> (Area code - Te3.tVhoz:w Number), <br /> Sketch (Detailed plan-*' may be submitted) <br /> TI a undersigned hereby applies for permission to.excacrats, construct and/or <br /> otherwise-encroach•Oa County,'Rigrhway Right-off-W on•the •N4 etre <br /> `' wide bf... . <br /> a� ` � � approximately .SSC] ee <br /> followit7�g work (descri t. by'pe�rfoxuiAq the <br /> ' work <br /> ion of;woxk) : <br /> ------------ <br /> ,. <br /> -Ila\C <br /> Work +will comr=ce on ox'about <br /> Lo Dfor appzoximatel, <br /> days. , <br /> X, rhe undearaigned ce'rtif'y that I am the owner of.the respective•property, or am <br /> accoqualrdantfied to represent the owner andagree • o do the work described above in <br /> accordance with the xul esp, reguj.atio='of Sana aoaqu�n C6=ty and ,subject to <br /> inspection and approval, i'�„�1.�Q►"S�C1ga <br /> . . t <br /> a=snature of ApPlicant - "title � Orl <br /> Date <br /> +wsz�.pi�sacomz cc/oo1 - � _' <br /> y <br />