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UUUIN I Y Ut- SAN JUAUUIN Date: i/ % <br /> Vi; ; ;'E, DEPARTMENT OF PULIC WORKS <br /> Received By: _ <br /> RIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> OFFICE USE ONLY <br /> Name:-L-•e arms =�#e�.�iLoc.,41 <br /> Address: 39 yti chemo oke JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: 4 c , - APN ��_33 FEE DUE: <br /> Area Code -Telephone Number: a o - q(, 3 EXP. DATE: DRIVEWAYS: <br /> U�L 10UNOZ STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: L q1o� , 4N - TYPE: <br /> Site Address: 3 fSq Ch«a ksc- z el FORMS: <br /> City,State,Zip Code: c.� o NOTES: <br /> Area Code -Telephone Number: d o?_ y(,[° - 33 'G <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: _ _ COMMERCIAL: W <br /> City, State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> v` side of G'�fE�^�f�� �r approximatelye� <br /> of A, -,2.t> by installing <br /> Work will j <br /> commence on or about ,-7&y ! - 3,o j,, for approximately Idays. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES _ NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALS``ERVICESICLERICALIPUB-SV.WKWASTER.PSVENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />