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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Apr. 09 2009 01:43PM P 2 <br /> APPLICATION FOR ENCROACStMV PERMIT <br /> ltd' <br /> Date �'�' 1 .. °� OF710E XYSF ONLY <br /> To: San Joaquin County JOB X340 REF # <br /> Department of Public Works AP21 0 # <br /> VAL .41 To DRrVMYs <br /> {Applic*nt Nance) STT 'x <br /> TYPE Uzi. 4oLC- <br /> Mailing Addross) POM <br /> NOTE <br /> (City" a.S�ytat{ey, .Zip Code) <br /> (Area Code - Teleph=o ry=ber) <br /> Sketch (Detailed il=s may be submitted) <br /> The undersigned hereby applies for permission to.exaavate, construct and/or <br /> othexwi.se-•encroac)a on 4County..aighway Right-of-Way+•oa•the gi de:,bf . , <br /> approximately _ 141 K /Mia* 'E 1 <br /> o£ miE by pe)r€ormi�tg the <br /> followimg work (c�esaription of;work) : ' <br /> ' ASN � . ., <br /> 3 ti <br /> NA <br /> Work will commence on or'about <br /> days. for approximatel, <br /> , <br /> I, the ed tos Undersigned cern fy. that I am the owner' of•the xespectiv0 -Property, or am <br /> guaIi£aed to represent the owner anti 4g ee to do the taork described above in <br /> accorclszice with the rule re5u]atitans'of San Jon <br /> inspection and n County and subject to <br /> a <br /> . Pproval,.�QIa�6�`C�� , <br /> s ' tun 4k5 -qB <br /> xg�aa a of Applicant - �t1e `�.• . <br /> Date <br /> t <br />