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FPOt,l :CALIFORNIA I,JATER SERU I CE FAX NO. :2094640195 Tun. 25 2007 02:25PM P 6 <br /> APPLICATION FOR HXn0AC== QMWT <br /> nates - _..' - ----- - <br /> TO: s #.-23z> 77 <br /> • r3�� <br /> S= soac�uitt County Jos #.— a 77 # <br /> Department: off Public Works APRT Clx � <br /> VALID -k-28-07 TO 0 <br /> A <br /> -/-a7 DRl^0' ,&YS: <br /> �• p �(Applicauat Name) STMT C*w&F �kA_G AD, <br /> ARIA► A✓4DAD AIS <br /> TYPE iw I <br /> (Mailing Addreaa) FORMS SS •Z <br /> (City, sbate, .zip code) <br /> (Area Code - Talaphoxte limber). <br /> sketch (Detailed place may be submitted) , <br /> Che undersigned hereby applies for permiSSiO n to.excavate, const ct and/or <br /> otberwise-eaeroaeh•on County.Highway Right,f-way-.6A e,-the 'NOS` did <br /> C��EF.OK. approximately $ Il)T <br /> of bL��` LDFa.I.' A ,. <br /> by performing the <br /> llow3.�xg work (des pt,ioa of wo ,,. '• <br /> ' X1 ' <br /> Work will co=eace on or-about for approximately <br /> Lob days, , <br /> I, the undersigned certify that S am the owner of the respective property, or am <br /> qualified to represent 10awAer and agree to do the work described above in , <br /> accordance with the rul9b, regulatioas'of Sant uloaVl = County and, $object to <br /> iaspettion and approval OB"a4_4z t ' <br /> Signature of Apvucaze •- Wille <br /> . Data <br /> ►049x1ut•P$�• DL !4/041 <br /> ' f <br />