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FROM :CALIFORNIA WATER SERI!ICE FAX NO. :2094640195 Jan. 07 2006 06:01AM P <br /> APPLSCATION FOR MCROACMaRT PERMIT <br /> mixsE PRINT: <br /> Date W OFFICE tys8 Omy <br /> TO: San. Joaquin County ,ToB A T?W77 �, � <br /> Department of Public Works A <br /> CR <br /> C i�1.e RC1 R�11 l� RCS <br /> EXP. DATE _ <br /> (Applia=t Nasse) STSt '1' Kezelu <br /> ARnchT /QUADTYP <br /> (F Ai l iZ9 Addro0rt) POR <br /> Foy <br /> m <br /> Nonr <br /> Y <br /> (City, Stat.o, .Zip code) <br /> (Area Code - Telepb=e Number). <br /> Sketc7; (Detailed plaa:s may be submitted) <br /> The undersigned hereby applies for permission to,axc avate, Construct and/or <br /> otherwrise-encx'oach•On 0OUnty•gtigbwa dight-of�ylay•oa-the . N. <br /> ofappro;cimately L side:.of • • , <br /> A lie <br /> ' by verformizig the <br /> . follow3.� work (c�.escription of.,work) : ' <br /> work will, cammetce: on or'about <br /> days.'. � for approxi.matel' <br /> 1, the undersigned cex'tifY,;b,at I sm the O <br /> qualified tO represent the o weer;of,tbe. respective'property, or am <br /> accordance with the rule rwaex and agree to do the j=k described above in <br /> �aection and "l$ti of San JOtIC .in C6= and aubj ECt to <br /> kt28 approval . '�.�`C19 . <br /> �.t�1R(��anE, - der cA�e; 'F R�� • ' . ' . . <br /> '5"9r=wre Of Applicant - Zi't3e _ t 09 <br /> Dam <br /> �.rxxot.prlr�sc�am to/oo) ... . <br />