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CAL I FORN I A WATER SERVICE <br /> FAX NO. :2094640195 Ort. 17 2007 l 2: <br /> • 11PI9P4 <br /> APPLX�ATXON FOR �",, ep.OA,CF T pMUa ' <br /> PL?�AS� PRINT� . <br /> Date .. (� `( -*7goa <br /> , oo i MUM IQs$ ONLY <br /> To: Saiz k'oaquin; County <br /> Department of public WorksVALTZ <br /> RS$ <br /> DATE <br /> (�a$13cant Na�aa) Sxx dLO Xy-1 To <br /> •1SSU W-TWM OW �R �,��, <br /> x°srng g4w <br /> y F11Z-U Sr Addroan) Fonrzs Gv�v -z9 <br /> (Citrt state, ..zip Cede) <br /> (Area Coda - Telephone HUmber). <br /> Sketch (Detailed , lans may be submLtted) <br /> xize etad signed hereby aPPlies foro� y� gig�ZWay <br /> sa"eM=oach.on conal permtsSion. to,eaccavata, nst t and/or <br /> lttght-o�-WaSr..�•thQ Q <br /> of approx�raa>�ely ,� ► g ' $i :.o <br /> llowt <br /> g woxk (dearcriptioa c►f Wo kj : by $er orming the <br /> � �•: <br /> Work commence on or•about - b <br /> days., forapproxijmately <br /> X, the undersigned certify that I am the o <br /> qualified to represent the owner and a �� of the respective Property, or um <br /> accordaace with the rul agree to do the work described above in <br /> . xeguxatioits-Of Sam �Taaquin County and subject to <br /> inspeatioa and aisiarorra,],��8: <br /> s� atwce of xitza — \Q " � + C)-1 <br /> • D3tta <br /> w.ar�.as�y�acmti cc/ao� <br /> Z <br />