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FROM :CALIFORNIA WATER SERUICE FAX NO. :2094640195 Dec. 18 2009 12:18PM P 2 <br /> "PLICATION FOR MCROACEMM PMWT <br /> $LEASE P�RIi�TT <br /> r <br /> ()Ab - <br /> Date ► 1 1. ' OFFICE USE OMY <br /> To: Sass Joaquin County JOg � ( REF # <br /> Department of Public works APN � <br /> Cit <br /> DATE _ • 1 Z 2to11 ai ' <br /> {App�,icrxut Name) <br /> 'kAo. -�1 Q. DRIVMyCS <br /> ( l ,g Addxoas} FORMS <br /> NOTE <br /> (City, Sr'ate, .xip Code) <br /> (Area Code - Tele,Qhaae N�tmbez), <br /> Sketelk (Detailed ilaua may be submitted) <br /> The undessigxaed hereby app3:ies for <br /> �� <br /> permis <br /> Otherwises oi_to.axcvars, �construct a..sd�/orrouzy.s ghway Right-of-W _Spay-oa-the , <br /> . . .approximately � <br /> ON- <br /> of <br /> following • ` , by'pexfo=itig the <br /> work (descr,�ption of:work) ; . <br /> 71L <br /> Work will commence asx or'about • <br /> a <br /> Por roximatel <br /> days. ., , � Y <br /> I, the underziqued certify, that I am the owner of,the respectiveproperty' <br /> zo x-t dr am to;repxeseut the owner and-agree to do the ;Work descrz)xd above'.in <br /> accordance with the r4 e4 xegulati 'of San 704",Cdu'aty and subject to <br /> inspection and approval. <br /> S..gnature of Applicant :. Title <br /> Date <br /> ro►rriaa.pr\ram c61003 _ <br />