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1115-a State Water Resources Control Board 113 s. Division of Water Rights Winston H. Hickox 1001 1 Street, 14th 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.ggv Protection The energy challenge facing California is real. Every Californian needs to take immediate action to reduce cr crgr ron cr 'n/ rum For a list of simple ways you can reduce demand and cut your energy costs. see our Web -site at http: //wwv .s rrcb.ca. gor. 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 Governor I III III 1111 I 1111 1111 11 A018031%2003 VIII IIII 10002232 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 retum 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: Address: No change in ownership'or address City, State, Zip: Assessors Parcel Number (APN) at point of diversion (optional): Phone Number:_( ) E -Mail Address: C7 t\) Box 2, Former Owner: (complete only for Change of Ownership) Owner Name: Address: City, State, Zip:- Phone ip:Phone Number:( ) E -Mail Address: Signature of Former Owner: Date: n) r -- Please return this original completed form to the address on the back. (Keep a copy for your records if desired) Placc Postage Here State Water Resources Control Board Division of Water Rights P.O. Box 2000 Sacramento, CA 95812-2000 Fold at this line, tape and add postage to mail: •a. Fold at this line