HomeMy WebLinkAboutRES 1947-19 - Board M
Y
[Domestic Water Supplies.Form Al.Municipal Corp a or Civil Subdivision]
STATE OF CALIFORNIA
BOARD OF PUBLIC HEALTH
Application from__...-----------------Tr_ucJ m__1h1b1 ►C_-UtL11_tY__D1&trJ&L----------------------------------------------------__-____--_----_---------
(Name of municipality or civil subdivision)
organized under----------------------- C-- t►.�1� -, .i#. � -- G-'�-- -- -------------------------------------------------------------
(State whether special charter or under general law,giving class and date of incorporation)
To the STATE BOARD OF PUBLIC HEALTH
760 Market Street
San Francisco,California
Pursuant and subject to all of the terms, conditions and provisions of Division S, Part Chapter 7, Sections 4010
to 403 S of the California Health and Safety Code and all amendments thereto, relating to domestic water supplies, application
is hereby made to said State Board of Public Health for a permit --_ --V__ +R - ►_ U _`__w __�_-_---_--_--._
eerving_Truckee_-lend_the Gate►w_Area,- &A� _+���#r__-�. - '��_#�__le-
Applicant must state specifically what is being applied for---whether to construct new works, to use existing works, to make alterations or additions in works or sources and
_A91__AX_e&_2d i aM't t__ Q__ __I ,--a]]..I An.._ nt�a�ur Ct ._N.' ._�-.. to CheA Pr. �.,3.ati �
state nature of improvement in works. Enumerate definitely source or sources of supply, kind of works used or considered (if known) and specify the locality to be served.
Report.
Additional sheets may be attached.
Dated (/- _._._. 19
TRUOKEE PUBLIC UTILITY "j 1 r .: F) t
AFiiX -----------------------------------------_--------------_________----------------------------------
(Name of municipality civil subdivision,in full)
OFFICIAL SEAL
HIRE
By ----------- ---------- -- ------- -------_---------------
(Signature of chief executive officer with official title and post-ogice address)
Attest:
01
�2
________________ __-__ _-___-----------------------------------------------------
--------------------------------- - - ----------J ---
(Signature of clerk or corresponding official witl;titl-e and post-o�ee address)
--------------j------ -----�"------ <Irr- --------- .____ ------------c_..r . -- --------------------
NOTES
Before making application for permit, such action must be authorized by resolution of the governing board, substantially in the form
furnished by the State Board of Public Health (Domestic Water Supplies, Form A2) and a copy of such resolution, duly certified by the clerk of such
board, must accompany the application.
16747 10-I9 ZM S/O