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COUNTY OF SAN JOA UIN <br /> Q Date:DEPARTIIENT OF PUBLIC WORKS Receive:�—/DRIVEWAY AND PAVED FRONTAGES CR# `3 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> F <br /> #11005 ISSUE DATE <br /> J� Name ,� /f/ - 2Gap _ �"�— FEE DUE <br /> DATE <br /> G� dress DRIVEWAYS: <br /> IV - - est EET (`7' <br /> AREA <br /> —QUAD_.&&)__ <br /> City,State-Zi Code TYPE v <br /> 17 3:3�i <br /> FORMS ww r « <br /> r� Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> fz �J 'A <br /> Site dresses t DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> ° <br /> la AAu 1A 1/,, �S ,3;�(� AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL ►/ <br /> INDUSTRIAL <br /> RESIDENCE @ R� <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Ft <br /> P1Address The undersigned hereby applies for permission to encroach on C un Hi jA"-W, 9 Right-of-Way on the �c� side of �� ghwayity,State-Zip Code approximately � 5�, �t/mile tme� of <br /> by installingrea Code)Telephone i M MIP ta1a s (see 15 «ry�D6 <br /> Ov l) <br /> will commence on or aboutWork <br /> c�Ui1G /5i� G� for approximately, 90—/20 days. <br /> SKETCH(Separate sheet may be submitted) <br />'ill this project be self-installed? NO k YES Contractor's License C'17 �'73 9P5e2-- <br /> xvss\Per AppTormlDrivewayPaved firontage <br />