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FROM :CALIFORNIA I..IATER SERI)I CE FAX NO. :2094640195 Jul. 25 2007 C12:59PM P 2 <br /> AP <br /> PLICATIOX FOR McRoAcmawT P MXT <br /> r, ,s� RENT:_ • ' ��� � ' <br /> DBtte %ti MOFFIC!5 ITSN ONLY <br /> To: San A ] <br /> unty JOS #�77 -�� �' # <br /> Department of Pubic Works APN # _ ; <br /> ��11 ` A' LST' p�! Sly. DA's �0- .,0'1 <br /> CAU 70�t� R V� ri l�7SIK 6 vnm o?-ZS-�1 TO la-1•o'l DRz'U^S us: <br /> (Applicant Name) ST=T Atrihie A- <br /> 154 TX'PNf.54EL4L �' _...... <br /> (Mailing Address) 1#O12MS <br /> rr°xZ <br /> (City, Stat*, .Zip Code) <br /> (Area Code - Talephone Number), <br /> Sketch (Detailed �lane .may be s6mitted) <br /> The undersigned hereby,applies for permission•to,excavate, construct and/ox <br /> otherwise-encroach.on county Highway Right-of-Way•on-the •h1D- .Nk. sid*;.•bf . <br /> fy1_fit 1'�C. AV E. approximately l 0 j ee a \MT� <br /> Of W .ti1I�'C_LL. RV's r , ]]y� "foxa>iAg the <br /> following work (description of work) : <br /> - � r <br /> Work will commence on or'about '� 'c�, p�{ for approximately <br /> Lo C9 days. , <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work descriled above in , <br /> accordance width the s, regulatiaD'of Sas JQaqudn County azd subject to <br /> inspection and appro . � <br /> .-'b.'IV�AC..�Aia'�O ~ QF'F.�t�C'Cl�t�1,5• C�� O`L' �3��_ � <br /> Si.g=t=e of Applicant - TitZe Date <br /> MIbS,A6.Y$\7YSgC�L fCJD6) • • <br />