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COUNTY OF SAS!JOAQUIN Date: 1 1 10 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: A)t <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:_Xm <br /> PLiCANT iI _ OFFICE USE ONLY <br /> Name: rs ----; <br /> G <br /> Address: a ( JOB# 11005 ISSUE DATE: <br /> Qq,Sw,Zip Code: s+ e.w , .S 3Gs i APN 'j S- -. FEE DUE: <br /> 1 Area Code -Telephone Number.tQ04 y © 1 EXP.DATE: DRIVEWAYS: <br /> l STREET: <br /> SITE INFORMATION: _ i AREA: <br /> �s�,Q a o,✓ DUAD - <br /> 1 Parcel Owrrer's Name ___/- 01 Y R ,z,. TYPE: <br /> S Address; FORMS: <br /> Staff,Z Com: ,,, Cc. . S' J O NOTES: i <br /> Area Cock -Tewfone N2MwD6 g J 6 <br /> j DRIVEWAY i <br /> i CONTRACTOR TYPE: <br /> Name: --I — QUANTITY WIDTHS <br /> AGRICULTURE: ; @,FRONTAGES <br /> C State,Z Ccxk: ---- i <br /> COMMERCIAL: <br /> R i INDUSTRIAL. <br /> - - <br /> �Area Code -Telapttor�e Number. ..- _�~- ; ; RESIDENCE: -� --- <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. i <br /> The undersigned hereby applies r permission toate,construct andlor otherwise en� on my H' Right - n the <br /> _ side of approximately !°Ni <br /> -- -:-of <br /> by installing <br /> commence on or about — --- Work wi11 <br /> for approximately days. <br /> SKETCH(ate sheet may be submitted) <br /> i <br /> i <br /> I <br /> I <br /> I <br /> i <br /> t <br /> Will this project be self-installed? `'ES NO Contractor=s License <br /> Lt CENTRALSEFtMESVCLER{CALFUS-SVSh'KSMtASTERRMBCROACriHNE T'PERKT OR:VEWP,Y.DX (WDS; <br /> Page^,of 2 <br />