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06/06/2011 13:51 2094640195 CAL WATER PAGE 02/03 <br /> Data r�5 Lj <br /> ,y a�'L�G'g' USEt�b5�ey <br /> 0: <br /> San <br /> Joat�usa Couatiy JOB # /J-'6477 �g � <br /> Dapartmet: of Public -works APRT . <br /> {Appli* t NNW) STT ET <br /> T .. <br /> A?Ing9wiz QMD AIK <br /> TYP9 2516LIg—A45 <br /> NOTE �AP <br /> zip code) <br /> Mraa Code - Telmph=La xftbar) <br /> Sk6tc, t&tailed pla= nlay be Omf.tted) <br /> (Of <br /> `i a =dersigz2ed hereby appki" for permissionta.axcaaatet oo runt .eud/ar <br /> ot120xViEe-encroach-or <br /> \� �� CouaztyY Rfght-of- Y as the ,de:.' <br /> appr= mately ee fbnile f O.u. <br /> fait 9� r by vmvformi.Ai the <br /> following work (e'lesariptioti, of;work) <br /> 17 �r .— <br /> Work will <br /> commence ar' t ^ <br /> --- �. da,;. . 8 1 s » for gra telt' <br /> It the utldersxgned cer'tifx that Z am.the owner of,tlse xis ective <br /> qualified to repxesexit t-I�.'aa�er p -pZop�y, or am <br /> and to 3o the ' , .deac wed above <br /> ngpeanaoraacetion and' <br /> the rr ear xegvlatiOms'of Saa Jckg44n C6=t:y and sub act to <br /> and approval, <br /> siguazure of AAp2icTtZ d 1. <br /> Date <br /> T'A6fi3R.Fs�F'�ib IFLDO} ` <br />