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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 <br /> • Dec. 01 2009 12:46PM P 2 <br /> APP7,ICAT3:0ar FOR BUCROACMUMT PER=T <br /> PL SE PRIM: <br /> Date Ak _ <br /> OFFICU USE ONLY <br /> To: San Joaquin County am $ 7-3Oc5 7._._� _ REP # <br /> Department of Public Works ppN <br /> C..� .� p♦p l Dm - ` <br /> . D <br /> �To ^1 20l DXTVEf ys <br /> {Appxicaat Name) S W <br /> TYPR <br /> AR$A <br /> FORM <br /> NOTE <br /> (niter, Stat,*, -UP Code) <br /> (Area Code Telephone Nix) <br /> Sketch (Detailed plans may be Sit t $tied) <br /> SUrL <br /> .AC <br /> The undersigaed bexeby applies for pesrcission to,excavate, aaastrLtet a=d/or <br /> othervrise-eacro <br /> w_a Q 'o� tY•Highway Right-of-Wa4r-c• L•the "'7 1 Uig <br /> •a£ approximately %() I <br /> following work (&scriptio7a of;work f ' exfozmizig the <br /> ' 1�1'h1 ''4Yr_IPA�R ) : ' <br /> __V-"Ur _ !� <br /> V <br /> VIRAnKN -IM <br /> work will co=*!ace on or'about <br /> l� <br /> days... for approximately <br /> it the undersigned certify. that X am the ownex' of,the respective-property, or am <br /> accord est to with <br /> the rignt: the oroPner and-agree to do the �r rk described above in <br /> inspection with the vole regulations'of san LTOixqu�'County and subject to <br /> inspection and approva�..�41"Z�i . <br /> �.1� ��1A� � ��� � �itis • ' • • .- ' • . <br /> Signature of: Applicant - Tide <br /> Date <br /> rns�t.piV=nmtc/acl - <br />