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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Jan. 05 2004 09:10PM P 2 <br /> APPLICATTON FOR ENCROAc== PST <br /> OPME DSN ONLY <br /> aoa # P # <br /> To: San Joaquin County C _.Department of public Worka BXP <br /> Ex1�, DATE , <br /> �� � ��V e iT,�►Li o TO /0 0 riRTVEWA)f3 a <br /> $TIiEg"•. All <br /> (Applicant Name) A� � QUAD A45 - <br /> TIGpN -gam ►�o��. <br /> (mailing Addseas) FORMS <br /> NOTE <br /> (cityr Sbate. •2ip Code) <br /> (Area Code Muzber), <br /> Sketch (petailed plans may be sus mitted) <br /> TQ undersigned hereby applies for permission to.excavate, cons- ct and/or . <br /> encroaoh on Courxb H3 ghway Right-of-Wavy oar.Che <br /> otherwifse• Y' \ZDV <br /> approximately V& <br /> .. ,,. kyr performing <br /> of vo)m <br /> following work (description of work) : <br /> J j <br /> Work. wri,7,l commence on or'about <br /> or approximately <br /> 100 <br /> days. <br /> Z, the =dersigrxed certify that x am the owner, of the respective property, or am <br /> qualified to represent the owner and agree to do the �iork described above in . <br /> accordance with the rut regulatious'of Sart IT CovxiCy axtd subject to <br /> inspection and, approv.,&-a ',c)ko <br /> Signature of Applicant 3, Title r)a►ts <br /> sssn.vs � (t/oo) <br />