Laserfiche WebLink
FROM :CALIFORNIA WATER SERI)ICE FAX NO. :2094640195 Jun. 01 2009 04:05PM P 5 <br /> APPLICATION' FOR, WCROACHMiEI T PERMT <br /> ,PT,EA3L PRINT: �'} 'Q <br /> Date orrics USE ortLy <br /> To; San Joaquin County aoB #_75077 REP <br /> n' Department of Public Works APN . # <br /> VALM &J-61 TO DRIVM*KS <br /> {1Lppliazat Mame) <br /> Ann �rarkr�n/ <br /> TYPE _gff66(;.f -E <br /> Mailing A,ddress) PORMs <br /> • �-X4'(1 . � `�r�,�� NOTE <br /> (C3ty, State, .dip code) <br /> (Arca Code - �e3.e�,pho:ae 2ltimbex) <br /> Sketch (Detailed plans may be Submitted) <br /> T6 I= raigned hereby app3;ies for permission to,excavate, construct and/or <br /> on t <br /> othe Wise•-encroach Couny <br /> 'Righway J .fight-of-way••oa.the <br /> of QRn P►11F 1 approximately _ Q 1 <br /> following work (description of:work) IT <br /> ' — by perfarMiAg the <br /> K <br /> Work will commence on ox'about CS ..� <br /> L D d� ,ys. for aPpxozimately <br /> I, the undexsagzxed certify tb t I am the ownsoff•the respective property, or am <br /> qualified to represent the owner and'agree to do the Mork described above iza <br /> accordaryce with the rule , regilati of San Z'oac in County and subject to <br /> inspection ani appro�, b� a„q-Q`�J • <br /> signature of APPlicaat -Title -- t �;.. Q�. <br /> Date <br /> (c/003 <br /> • t <br />