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09/22/2011 12:34 2094640195 CAL WATER RAGE 02/03 <br /> ar',:',w<<re Fl�f'S 3? *= : e :l ��(1?-C?i ',ill'• ,J: e �'•�. �=;1Mc 4. <br /> DE'Daitneaxt Of OL-1�'s .���t5 <br /> b . : x <br /> �]EEa��� g e3rasa� p4 ��G 5S w�j g-?S_ <br /> (Citi-, Stata, .Zip Q,da) - - - <br /> w �� - — - <br /> (Area Coda - Talephona Numbar) -- -- --- _ <br /> sk4tdA (n-tailed plano may be sbYmit'ted' , <br /> Tis tzvdersigmad ha aby applies for paxmissio= 'tD,WCaavate, const=ct 'axxd/or <br /> otiaeev Be-encroach•can •countyt•agrkmay ;igbt-of-WLy,.,o.a•t-le ' . r;ridf;,6f <br /> approxi araately ,ti.c'S set �ntle ` <br /> .of pe=:zor;�i7Q the <br /> ftsl�awiaxg work (descriptioxa of.work) . <br /> i+,Ter rill aatt�tteace oa vr'about 1! for approximately <br /> TQC <br /> day-$. <br /> 1, the =dersigued oextifyr that T am the,ak=er of the xespeatave.•.propeatyv 01 am <br /> qualified to ,repres4,t the Omar asci* agree to do the work descried above, in , <br /> aeeordmae with the xt%lp-s r xegv3 ations of Sam Joaga,�z County aad subj'ec't to <br /> inFpeotion a:,d app=va7 <br /> signmt:=e of applicant - Title Date - <br />