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COUNTY OF SAM JOAQUIN Date: C 16e—2 e I I <br /> ' DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: O_ Ci�Co 2 <br /> APPLIO OFFICE USE ONLY <br /> NWW. IfAJ <br /> Adis I'-&- 2 JOB# 11005 ISSUE DATE: <br /> Cft S e,, Code: � I�*Cri::- APN 2 o?-2dv 20 FEE DUE: <br /> Area Code -T NdmbW. 2 16 Y 7 EXP.DATE: DRIVEWAYS: <br /> STREET: I> a CJ QS rz . <br /> Sa!EORMATM. AREA: ESCGf_rih QUAD F-- - <br /> paws Raw. TYPE: I VC w�� <br /> � FORMS: S W #<( -7 <br /> . ......, NOTES: <br /> ArmCode - <br /> Telephohe Number <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Now, AGRICULTURE: @FRONTAGE <br /> Addrew COMMERCIAL:. <br /> She, 00cle: INDUSTRIAL: RNV <br /> Ar Oode -T Number: RESIDENCE: 1 <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T�etrderaiied hereby applies for pemvissaon to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> -C&IP of De,, 1z `, approximately /2O0 ( eNmile <br /> of 04ic r—t Car" ej t t�'Vc . ^ ,by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(SapwAa dwet maybe,soba tted) <br /> WVI this project be self-ir led?' YES NO Contractor's License <br /> UAVMMORGMAREVZOORALSERWEAt WU6 SV.\hnfitlASTERPS ENCROACtM IEWf PEPW ORNEWAYDOC (40109) Page 1 of 2 <br />