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FROM :CALIFORNIA WATER =;ERUICE FAX NO. :2094640195 Mar. 30 2010 01:29PM P 2 <br /> APPLIbATxON 170R ENCROACMWT PERMrT <br /> PLEASE P)tINT: , <br /> Date OFFICE USE ONLY <br /> To: San 7oaquin County aoa #. 3DD7'7 # <br /> Aepaztmeat of public Works APN CR _ # <br /> DATE <br /> S A1C , VALM •�9ivy .,�aia , b�roma�Ys: <br /> {APPlicant ftme) <br /> ' 155 <br /> T"S 6 r <br /> ( 1�7ag Addroas} FORMS <br /> CONNOTE <br /> (C3tY, S <br /> tate,e.-Zip Code) <br /> (Are" Code - Tei Vhone Neer) <br /> SketclA (Detailed pla= may be Sb)b fitted) <br /> MAP <br /> The undersig n' ed hereby-applies for permission <br /> otherto.excavate, cozzPtx�tct and/ox <br /> yn,s ezYcroach oa Cotuaty.Hi ghway Right-of-waryuoa•the S- -46* .. 9,doI <br /> of approximately 4 _ �rfe�/mile <br /> f ilowiagp�,rork (descPaYformig the <br /> `_.�. <br /> o <br /> Work will cl-=ence oa or'about <br /> da Ys• for approximately <br /> 1, the vadexsigned certify, that z am tboe owner' o£•the respective property, ax ant <br /> qualified to xepxesent tbs owner and agree to do the work described above in <br /> accordance with the rules, regulatioz7s'af saa 1T0a <br /> inspection and approval. m Ccmnty and subject to <br /> �.d�rad..•rp�• • . . , . <br /> Si at re Of AppYicaut - Title <br /> Dat e - <br /> 14xL'rfet•gty 16/007 � ._, • <br />