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vJM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Aug. 10 2010 10:08AM P 2 <br /> APPLICATION FOA ENCROACMMNT PEfiMIT <br /> pLF.ASE <br /> PRINT: <br /> QJ QQ <br /> Aate 0rrxC& USR ONLT <br /> To: San Joavin County J08 �. ��7� REF 4 <br /> Department. of Public Works AP9 CR # <br /> FX►'�. DAT$ � 0 <br /> vALzv o TO v �s >o DRXVaAYS: <br /> (Applleant !fame) S' &V +� <br /> 1 � 4:M TYPE <br /> Q <br /> AYMA S <br /> (Mailing Address) FORMS 0ad <br /> NATE . <br /> (city, stake, .zip Cod*) <br /> . (Arei� Code -• xe�.vphozio b7�ber), ' <br /> Sketch (7)eta fled plans zay be submitted) <br /> The undersigned hereby app9;ies for permission to.exe, avate, constmuct and/or <br /> of se-encroach•on •County Eighway Right-of- +•oa-the ;_ -- Vidi.,of,•. <br /> rox <br /> appimately „ ` ee Jmile j.a'of f <br /> £ pex£oxmirsg t3xe • <br /> o _ g Vork (cdescriptiom of;work). - <br /> Work will commence on or'about for approximately <br /> a days . . <br /> x, the undersigned certify that x am the ovnpr of,the respective.•proparty, or am <br /> qualified to represent the owner and,agree to do the vaork described above in <br /> accordance with the rales, rq9kjtiO=-Of San %70aga3 z County and stab]ect to <br /> inspection and aPProv�j. <br /> I () <br /> Signature of Applicaant tv to D3 e <br /> �AC1�t.MtTL t6/po} ., <br />