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CALIFORNIA WATER SERVICE <br /> FAX NO. :2094640155 SEP. 16 2009 02-:42PM P 2 <br /> APP C T aN Fait MCROACMaM PENT <br /> PLEASE <br /> APJTDate <br /> orncr low ONLY <br /> To: San Uoaqx%jn County <br /> artmen jos <br /> De 73� � <br /> P t of Public Forks <br /> -�- - . <br /> F,7C1?. D&TE ,r('�5�DSI <br /> VALID TO �s o <br /> •I�it��:�� fir ! � ,(a��_ <br /> TYPS Eco hoot E <br /> (Nailing Addz•aua) <br /> FORMS s L✓,w, ..gt <br /> (Cit-y, S'tatto, Zip Code) <br /> CC 1A <br /> (Area Code - Telephone -W=ber) <br /> Sketd3� )3Iaus maty be ej2 matted) <br /> The UtsderSigned hereby applies for <br /> otherwise-encroach.on Pexm4ssion to.excavate, construct aTad/or <br /> County.H�.ghwaY RiSht ••0a.Vie • <br /> of approximately <br /> f /pti,3e <br /> follawing work (rtes ' ' •' by VerEOxuig <br /> cmption o f:work) : 9 the <br /> 71T 7 <br /> Work will commeace On or'about •_,_•� <br /> days. for approximtely <br /> � the und6raigned cert <br /> gva.aified t o that 1 8= tk►e owner' of.the xespecrjve •property, or am <br /> resesxt the oW�aer anti-a ' ee to do <br /> accordance with the rule � the work described above in <br /> �spection and approval. f ,`(a� ,of San ,7oggt,,uD County and subject to <br /> signature of APPxiean QLTRV <br /> . t Tule <br /> :sasrai¢.}•il � Dato <br />