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StateAter Resources Control Board
1111.111/ Division of Water Rights
Winston H. Hickox 1001 1 Street, 14'" Floor • Sacramento, California 95814 • (916) 341-5128
Secretary for Mailing Address: P.O. Box 2000 •Sacramento, California • 95812-2000
Environmental FAX (916) 341-5400 • Web Site Address: http://www.waterrights.ca.gov
Protection
The energy challenge facing California is reaL Every Californian needs to take immediate action to reduce e wig • r r nsun prom
For a list of simple ways you can reduce demand and cut your energy costs, see our Web -site nt utp://ww r.sur •rb cn gr
Application ID:
SOUTH TAHOE PUBLIC UTILITY DISTRICT
1275 MEADOW CREST DR
SOUTH LAKE TAHOE, CA 96150
OWNER(S):
SOUTH TAHOE PUBLIC UTILITY DISTRICT;
11
Cray Davis
Gn,'ernn,•
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Assignment or Address Change:
To inform us of corrections to the name(s) and address(es) of current water right holders, please complete Box 1, and return
the original of this form to the address on the back side of this form.
If you are no longer the owner of the water right referenced above, you must inform the Division of Water Rights of the
change in ownership by completing boxes 1 and 2. If there are joint owners of this water right, you must provide the names
and addresses of all joint owners and designate one person to receive all correspondence from the SWRCB regarding the
joint application. (Wat. Code, § 1290; Cal. Code Regs., tit. 23, § 691.) For more than one owner, attach additional sheets.
Box 1, Current or New Owner: (complete for Change of Ownership or Corrections)
Select One: Individual/Sole Proprietor Husband/Wife Co -Ownership_ Partner/Co-Ownership_ Corporation_
Estate_ Limited Partnership_ Trust Limited Liability Company_ Joint Venture_ Organization/Association_
Owner Name: No change in ownership .or address
Address:
City, State, Zip:
Assessors Parcel Number (APN) at point of diversion (optional):
Phone Number: ( )
E -Mail Address:
Box 2, Former Owner: (complete only for Change of Ownership)
Owner Name:
Address:
City, State, Zip:
7J
ry
Phone Number:( )
E -Mail Address:
Signature of Former Owner:
J
Date:
Please retum this original completed form to the address on the back. (Keep a copy for your records if desired)
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State Water Resources Control Board
Division of Water Rights
P.O. Box 2000
Sacramento, CA 95812-2000
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