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�; AN JOAOUIN Date: 1 1•''-� ��_ <br /> Received by <br /> ISPARTMENT OF PUBLIC WORKS CR# <br /> 'VEWAY & PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFlcE USE ONLY <br /> JOB# 11005 <br /> ISSUE DATE <br /> Name APN OU FEE DUE - <br /> �`1 L` �.�� � -2– I_y6 DRIVEWAYS: <br /> EXP. DATE <br /> "�— Address r • /j" �'i.l <br /> STREET • ,�, <br /> AREA h QUAD <br /> city,State-Zip Code • �x <br /> TYPE <br /> FORMS too –1 <br /> (Area Code)Telephone NOTE <br /> SITE IN <br /> - C DRIVEWAY <br /> Parcel pwne(s Name <br /> TYPE QUANTITY WIDTH <br /> She Address FRONTAGE <br /> AGRICULTURE <br /> City,State-Zip Code COMMERCIAL @ RJV�I (o p <br /> INDUSTRIAL <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> Name LENGTH--�)�2Ft. X WIDTH: 1 Ft. <br /> toss u CA 4 . <br /> Address <br /> Ad c4n, 41 <;�DL The undersigned hereby applies for permission to encroach <br /> y Count g <br /> on HighwayRi ht-of-Way on the v2 side of <br /> city.sate-Zip Code `\ approximately <br /> (Area Code)Telephone 0�7 e mile <br /> of GSC-'�,,�c R. 2r <br /> dam, ,pct by installing ��- �`r`"��L` A�— <br /> Work will commence on or about V `� �`��,5 for approximately days. <br /> SKETCH (Separate sheet may be :submitted) <br /> be self-instal!ed7 NO YES <br />