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FROM :CALIFORNIA WATER SERVICE FAX NO. :2094640195 Nov. 04 2009 02:46PM P 2 <br /> APPLICATXOZT FOR MCROACMWT PERMIT <br /> PL�It;E PR.�T: • . • <br /> Date07=9 Qs8 GILT <br /> To: Swa aoaqu:i n County 1708 # ZA97 _ REP <br /> Department of Public Forks AM <br /> . CALF F'CS��1� �,{� . I�A.TB •t�Q • <br /> VALM /(• 3.0 To C.1-5 /Ur,, D&x'P MYS: <br /> {Appy car t Name) <br /> STRUT ►oI- <br /> �i✓E, <br /> A A/ QlAD GG <br /> tNa3listg AddrQrxt�} <br /> FORMS <br /> •�n NOTE <br /> (City.,S`tats,1!.zip Code) <br /> (Area Code - Telephone X=ber), <br /> Sketch (I*tailed plans--May be submitted} , <br /> The undersigned hereby,applies for p&=ission to.excavate, ooz:struct and/ox <br /> otbAa wise-imcroach•On county � <br /> CT'Q l�\ g Y Ra�ght-of-way••cn the <br /> .of !� Pxoxytnately . gip' <br /> £ol�owin "`' '• r. . by''peVf0=Airig the <br /> g work. (description of;work) : <br /> Work wilX c0mnteU0&- on or about « <br /> for approximately <br /> i, the undersigned certify. .., sex of,qu4lthe respective roe <br /> that z am the o -property'rty' or am <br /> accoi me to represent the owner and agree to do the wiork described above in <br /> nSpeectiou and approval the es��reg te with xlat 0 :of San �7oaqu 'Cc►uzxty and subject to <br /> f , <br /> "9=zLt,=e Of APPlicant <br /> Date <br /> t <br />