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;UUN I Y Ul 5AN JUAUUIN Date: ?//47 <br /> DEPARTMENT OF PULIC WORKS <br /> +� Received By: <br /> -'��c3tl <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: eA�S25-.3 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Ad, JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN 179-D Vo- 06FEE DUE: <br /> Area Code -Telephone Number: ' c% EXP.DATE: DRIVEWAYS: <br /> STREET: ,eD. <br /> SITE INFORMATION: AREA: QUAD !!5_c- <br /> Parcel Owner's Name: zd4d 4 V("- A TYPE: L✓ <br /> Site Address: �,S �, �'�'' FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: 1 J <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: X <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 Hi hway Right-of-Way on the <br /> side of (' fe <br /> approximately /3 0 0 r gkmile G1f <br /> of i? TJ, Oa1;:f; T__, by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> 1ISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASrER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10109) Page Iof2 <br />