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COUNTY OF SAN, <br /> qA <br /> IN <br /> DEPARTMENT OF PULIC W6WS 0 we <br /> :. <br /> DRIVEWAYS AND PAVED FRWAGgS Received By. <br /> PERMIT APPLICA"'t <br /> APPLICANT <br /> Name: ( - <br /> Address: S -� t — — � Y <br /> City,State Zp Code `" z. v r <br /> JOB <br /> Area Code -Telephone Number. n APN I�-BATE: <br /> 13"r . Y <br /> EXP.DATE: <br /> SITE INFORMATION: STREET: YS: <br /> ParcelOwners Name: AREA: <br /> Sde TYPE: <br /> �Y,State,Zi �� ,�;�.,� v'L * <br /> p Code 4,. FORMS: <br /> Area Code -Telephone Number. a ` NOTES: <br /> CONTRACTOR DRIVEWAY <br /> Mame: TYPE: <br /> dress: - AGRICUL 1A Ti IS <br /> ,State,Zip Codi_ COMIKAE> A <br /> A�9a Code -Telephone Number. INDUSTRfAL <br /> ----- __ REStDE{+ } 1 <br /> LENGTH: Ft PA 'i <br /> The undersigned hereby allies for Ft <br /> ' side of ,fpa pee�missioo excavate,construct and/or otherwise e <br /> rcOachpn <br /> of <br /> approximately Com" tr f <br /> by kistaft 4 1 1 <br /> commence on or about_ <br /> _ for approxima�fy, <br /> SKETCH(Sep ra at hse est may be submitted) <br /> days. W0Fk wig <br /> project be self-installed? <br /> ______YES --NO Contractors License <br /> UPM <br /> W..ORGOW'EMEMRAL,Ia:"ICESaERICAL"18-sv.WKU'%STER.PSIENCROAaW,pERM IMVEWAY.WCt <br /> �WX4 page 100 2 <br />