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FROM :CALIFORNIA MATER SERUIC-= FAX NO. :209464019, Hpr. 18 20U� 12:2tiI'l r 2 <br /> AppL3:6=10N FOR HXM0ACFX= PEWT L <br /> Data C1T R�L r +• c�� oplacsMMY <br /> To; Saa abaT in Co+anty ao077 _ <br /> mpartmeat of Public Works APN CSC # <br /> AA pp� `� EV.. DATE <br /> STEM VALM --i<-z6 TO 7-1zor� DRV'=YSi <br /> (applicant Namw) S "t'" <br /> c `, r + O�m , ARE71t'a, k�t,lel Q= - <br /> Jti3 W 1V 1 TPS <br /> (Mailing X►ddress) rows <br /> (City, abate, .zip code) <br /> (Area Code - Te1ep]mao N�bex), - <br /> Sketch (Detailed plans may be submitted) <br /> T6 undersigned hereby applies for pe=jssi0n to,excavate, construct and/or <br /> otherytise-encroach,on Cot=by-gighway Right-oY-V&Y..oa•the • �/ W . sidp�'-bf.., <br /> t� . apprmdm atelyU.� fae �" H <br /> 1l <br /> 04 NY I , • ' A. . , by'pergormiog the <br /> following work (description of work) ; <br /> �1 ..(] •, nSTI. b� <br /> Work will commence on, oar•about dor approximately <br /> days., <br /> x, the undersignted certify that r sea the OwAex of the respective property, or ane <br /> T-taUfied to xepzesent the owa= and agree to do the aiork described above in <br /> accordance with the zvx , xe9V2Atioas'of San T'oaqudA County and subject to <br /> ivappection and approval�C)to..l�3•'4$� <br /> sigziatexxa 09 Applicant - T3.tle Date <br /> 10►i�tAR.t?8►IQ7C®L 16/003 , <br /> L <br />