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01/10/2012 14:40 209464CI195 CAL WATER PAGE 02/03 <br /> ag <br /> • Depar`ctne�.t a;� �u`J3.ir Aaxka �I� a'-' ` ��..-=-----. <br /> 1740--1�6 - <br /> . a..-ER _ FTt20l Z <br /> t?+Qaf11 g �cldra&a} FORMS (A <br /> t <br /> NOTE <br /> (C3.�Statla, .Zip COW - <br /> (area code -. Televhoaa wMab=)• <br /> sketch (Dib-tailed p9=s. may ba ffbbmitted) <br /> � e imdRigned hereby appli as for pexmisaicc•to,excavate, eozss sixet `and/or <br /> btharuri6e-encxtsach oa Ca qty g�itaa R�ght-o£•-V •••aa•tln <br /> � � appxox3mately fQe /mi.le <br /> 'of W&*7 LA_( oi'.) t . f hjr.. exi:axzaixtc the <br /> follming work (descriptim af,work) : ' <br /> i�oack will comance ca or' far mx.matelr <br /> Lib dam• <br /> T. the =&=signed oertxfy tit l am the, owner' of,the xespective•PZ+pe ty' or, am <br /> L3123Zit�.ed o represent the. tfiT�Pr R79f 'agree-to do. Che ;jOrk dascri. :d above is , <br /> accordanoe with the rales, regulatioaa'of saz JcAC,�Ti'Js. County and gvbjeat �o` <br /> y Tspection and appxova2. ' - • - <br /> signat=a o£ Applicant Ti-�.a to <br />