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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Feb. 19 2006 04:20PM P 6 <br /> APPLICATION FOR ENCROAC NT PERMIT <br /> Dene b �-• _ OFUCS USE ONLY <br /> TO: San loaquin County J08 # . RSP' # - <br /> Department of Public Works <br /> A-T � "Su\4 , DRIMAYS:� c - <br /> (Applicant Name) STREET iLcLdQ <br /> WalAing address) roRMs A ww �- <br /> S'toc� o%A �C� �S�4 3 N= <br /> (City, Sbate, .Up Code) <br /> (Area Cade - Talepbone Number), <br /> Sketch (Detailed plans may be submitted) <br /> Tx a under-signed hereby,applies for permission to.excavatio ct and/or <br /> o rwiss-a croscb'on Couaty.8ighway bight-of-wary. a•the sido.'Lo •�_ . <br /> t1 approximately � f <br /> of , by" erforming e <br /> flowing work t)( scription of work) : � � <br /> � � z <br /> Y ' <br /> Work wi ' commeace ou or'about for approximately <br /> x, the undersigned certify that 1 am the owner of the respective property, or am <br /> qualified to represent the ow,aex and agree to do the woxk described above in , <br /> accordance with the ruts, regus-at ns'oP San Toaqu�, County and subject to <br /> inspection and approval <br /> �0 •\�-Q' <br /> Sf.9=tuxa of Applicaat - ftle Data <br /> �aaxsx.ps�v�a ca/oo} ''� <br />