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:CAL:FORN I A i,JATER SERVICE <br /> FAX N0. :2094640195 Aug. 20 2009 11:23AM F 2 <br /> ApP SCAT ON F�� MTeROACM=T PERMIT <br /> PLEASE 4PIT <br /> Q <br /> nate <br /> OP71cx USX ONLY <br /> To: San c7Oaqain COunty <br /> Depa-ttme=tof d xc works <br /> AP <br /> { p icant rT j VALIb TO L <br /> tilJ� ema STRIMTARM <br /> D <br /> (�ai.xing •�ddresaj E'OS�S sS �- _��f"`----•--- '" <br /> NOTE <br /> (City, State, .xip Code) <br /> (Area CodeTTeleQh�a�a rTum�px) <br /> Sketch (Detailed plass be <br /> Y 'mar Silb�ttsd) ' <br /> T6 undersigned hereby.applies for <br /> athezwvise-encroach•on Faust .. pern'�ssiaz► to.excavate, construct and/ox <br /> of Y -lis"Way <br /> I I Dida:.ot,... „ <br /> fol3,owing work (clescriptxou of:wark) ;f <br /> • by ex£axmitig the <br /> Work o ixx co=tence ozc or'about <br /> ----- _._.__ days. aPFroximael <br /> T' the ,adexal e r <br /> 9n d cextify that z am the Own <br /> '--r'to represent the ay�r and ex' oE.the xespectf�re -property, <br /> accordance with ,49'ree to do P Peaty, or am <br /> the @ �, the work described above ja <br /> inspection anc3 app vat . Q- b�.of Sam c7oaq��'C6=ty and s!tb j eet to <br /> ra . <br /> of Appaicazxt Title <br /> .piL to/oo3 Dato ,. <br /> f <br />