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COUN TY OF SAN iOAQU11N Date: <br /> DEPARTMENT OF BUILIC Vi1`ORKS � <br /> Received B��: C.6.=-- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#- b Lt 3rI <br /> i APPLICANT OFFICE USE ONLY <br /> !..Name: -Jr1&1 C."<O-f C, l i�_- <br /> j Address: "4 .: J c,iq,, fg 1, JOB 111SSUE DAT <br /> 1-- <br /> I <br /> Cil&y,State,Zip Code: �-c ,% C ;' _j ; APNv -32 FEE CUE: <br /> i Area Code -Telephone dumber: v _q EXP.DATE: ORiVEWAYS: <br /> --- , STREET: <br /> SIlE:NFORIAT.,ON. AREA: <br /> _ QUAD <br /> i Parcel Owner's blame: , it y J c� —i � TYPE: <br /> i Site Address: r[,h, rl I i FORMS: —_ S✓tvu� t � " I <br /> iCity,State,Zip Code: <br /> Area Code -Telephone Number: — <br /> i <br /> DRIVEWAY <br /> j CONTRACTOR ; i TYPE i vUANI T ITY _ 'WIDTHS <br /> Name: i AGRICULTURE ,8FPON TAGE <br /> I Address: COM MERCiAL: <br /> City, p -- ---- j lht?USTRIA <br /> Ci ,State.Z Code: _ - i i j L <br /> i Arca Code -Telephone Numbeer: — ; RESP IDENCE: i - � ---u-- -' <br /> j PAVED FRONTAGE i <br /> LENGTH: Ft. X VVIJTH: — Ft. { <br /> The undersigned herebv applies for permission to excavate construct and/or othemv ise encroach or.County H' `way i �t-of-Way on the <br /> side of ??i ��? v approximately _ fee' 1 i[e <br /> by installing_ _^__---------___--_ <br /> —'JVoric wriI <br /> commence on or about- - i for approximately da <br /> -�--- ys. <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> I <br /> 1 J.. .. ..... 4 1 <br /> 1 <br /> -- <br /> t. <br /> I +� ,tf��+Jic lil�✓a ---'-."...---"/ �' �(�w b"el' �' )�f �i t.�,Jt^eYl Z�v. I <br /> i <br /> I I <br /> Will this project be self-installed? ' YES NO Contractor's License <br /> U�Eti1r.ALSc'R'd:C'c3`,CLr.1CAL,P'v5-SV.iYAtMk,TEii.?S7�;CROaCriR+E.kT P^cP.buz CRPvc 1AY.000 (7'J,'i5) P�,z;ci2 <br />