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FRON :i_HL I FLiR'hJ I H WATER SERI,!I LE FHS' NO. :2209464019-7 <br /> Jul. 24 2,G:0g 1A:11HM F' <br /> APPLTCA=09 FOP ]wcRoAC T )PETMaT <br /> PLE�ISE � , <br /> Date <br /> OrrzCB USX ONLY <br /> To; San -'oa:qu.in county ''Ob �1 REP # <br /> Department of Public Works APK CFS # <br /> VALM?•Z 2, •v9 To o. .o bIt7V7�WAYS <br /> • {App3ieat�t Wamc,) ��••• �•' <br /> TYPE <br /> (Mailing Addrosz;) FORMS ---- <br /> NOTE r, <br /> (City,"State' .zip colo) <br /> (Area Code - TelephoW Runber) <br /> Sketch (])etailed plans may be submitted) <br /> The =deraigaed hereby applies for <br /> othexeriae-eacrQaah on Count .. Ps�$sion to,excavate, c0=trUct and/or <br /> N, t{ .�I y gb Y :Right-of-Way••oa.•the <br /> aPprdximately _ tv 1 J3 e _. J4►t'.�i <br /> folXa ag work (descriptxan of:work) _f by pexfoxming the <br /> • �_ . . 7, <br /> Work will co=ence on ox'abaut •�pt� fl00 <br /> ------�•--------- days. . for approximately <br /> the undE:rsa.gaed cern <br /> that I am the ow7zer' of,the respective 'Property, <br /> or am <br /> to represent the owner and agree to dQ the work described above 3n <br /> accordance with the xule , xegvlatioxts'of Sexy Jai <br /> inspecti�oyz and approval. n Gouyaty and 8t4bject to <br /> 4a�a oq. , <br /> CS <br /> SiSnaLt='a of APPlicaat Title <br /> ' 73rito • <br /> • t <br />