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FPC'M ::_ALIFOPNIA WATER SERVICE FAX NO. :209464E195 � <br /> Jun. G_1,, 2009 02:(K3PM P 2 <br /> APPLChxxON FOR ENCROAC pT <br /> EASE PRINT-. <br /> Date J U��; 01� <br /> OFFICE USE ONLY <br /> To: San 70aQuin County <br /> Department of.public works X705 REP <br /> C9�Li'FC1R�!t Exp. DATE 6 <br /> VAL <br /> {kpplicant Drams) — m d9. 8 S' GF <br /> STREET � xs: <br /> L�A <br /> TYPE -Br-Lc. H Miailgg ada s) --- ----- <br /> PORMS <br /> NOTE <br /> �Sbat�e, 2jp Code) <br /> • (Aria Coda - �'elephone 37moQber , <br /> SkBtr M6tailed pla 'may be si"i.tted) <br /> The underaigned hereb <br /> otherwise'-eocroa °Sy aPpZies for perraisgion'to.arcavate <br /> - AV by..Highway Right-of.- a .Q Onutxuct and/or <br /> of "F�\f approximately 1 �Re — 8ide:.af,. • ' , <br /> e <br /> fO�.lowi2z9 work (desCr ion '• " .r. <br /> iPt Of:work) ; by Perfo=4149 the' <br /> y �. . ., <br /> Work wi : . <br /> 4 <br /> 1 Coma°ence On Or'abo-at <br /> days. for approximately <br /> x, the Uadex$icMed certify.. <br /> Qualified to re that I am the owner• of <br /> present the owner the xespeCtive .propesrty,' or am <br /> acaorctanae with the rare r 'and,agree- to do the sdork described <br /> aaspection and a Yl e5 atiens'Of San a� abovein <br /> pproval. Q$:qy qcj'� c uzn County and subject to <br /> Signature of r <br /> y <br />