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FROM :CALIFORNIA WATER SERVICE FAX NU. :20LJ4b4U1'=5 r e.n. ejo eVjelo lu.J7nl I I <br /> APPLICATXON Fan MCROACM=T PERT ' <br /> Ante Vit` ©YL } Q OFFMC S =N ONLY <br /> TO'. San k70agUfZ COMty '70B # 730 REF # <br /> Department of Public Works APN <br /> W. DATE <br /> Tr <br /> (APpiiCant Nams) STAT 9 s-r,¢�- * <br /> ARRA. �.K-M;� Q= ss <br /> TZPS No�� <br /> (Mi ling Addroan) FORM _.1b 4zsdr 14 h, wo <br /> Nam <br /> (Cityp state, •Zip code) , <br /> (Area Code - Telaphoue Neer)• <br /> Sketch (Detailed plans "may be subrad.tted) <br /> The undersigned hereby,applies for permission to,excavate,, construct axed./or <br /> otherwise-encroach-on county 91glaway Right-of-Ain ory the ,;, ( ' bid '.,of• . <br /> _ <br /> approximately � <br /> of•..wl, r� r , _ I �' , .1. • I by Cerforming the <br /> followingWk (description of work) - t <br /> �- •♦ r _T f <br /> r w <br /> WorX wjill commence on or'about r approximately <br /> days. <br /> x, the undersigned certify that I am the owner of the respective property, ox am <br /> qualified to represent the owner and agree to do the vaoxk described above in , <br /> accordance with the rulep, regul$tioz�f sau aoaqu�n County and subject to <br /> inspection and approval <br /> Si gmtare of Awli,cant •- Ti:tle Elate <br /> wsxr�.vs��aoma t6/aoi `• <br />