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FROM :CALIFORNIA WATER SIERUICE FAX NO. :2094640195 Jan. 27 2004 04:29PM P 2 <br /> "PUhTION FOR 4TCR0,ACMMW PF UIT <br /> • PLSAS PRINT s - . <br /> Date 1 790.J <br /> OPPICS 1138 ONLY <br /> TO: Saiz acaqui3a Comty JO � <br /> Degartm�ent of Pubj4c Works L <br /> CA t ORNt �Irt -( R S'E�V APN <br /> E"• OATS <br /> VALTI> TO <br /> (Applicant Nests) sz'REST 01&Pr✓J 'ea�Y�� ,' <br /> 1 S50�t .FFii . 10t <br /> Ate. �-2L,��-6,�_ Q <br /> TYPS <br /> WAiling Address) <br /> (City, State"ZIP Coda) ; <br /> (Area Coda - relephoae "or). <br /> sketch Metalled plane May be submitted) <br /> The und'31Sued hereby applies for pexmissio3* to,excavate,OtbA wise-encroach-on C!0uuby Highway RAgtxt-of-Way-oa•peWCon$t�tct and/or <br /> cf�WASL `' aQarox3asatelyQ eC�/tae <br /> follo t" bY' exLaraeinge <br /> 9' work {descrsptioxx of work) <br /> 1.3c. <br /> Work wUl aommeace on prabout <br /> kl• A- <br /> 10� <br /> days.. - del for approximately <br /> 1, the undersigned certify that z am the owner,of the respective Property, or am <br /> gLmlified to repxeseut the owner and a�gxee to o the woxk described above in <br /> accordaxece With the ru3.e zr-g ati,onp'of San. a0a(VAd- . County and a+?la�iect to <br /> inspecticm and approval.(C.51 &-j 0`a� . <br /> "�•M�' k�1AS�O r OF�.'�RT1b'h1�, CL�.IC�k� . <br /> Suture of AppZicawat tri txe <br /> Date <br /> DD (6/003 <br />