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�� <br />4�,,.,r��,��:a��'�.. <br />..�--�,�� <br />` � COUNTY' Of= SAN JOAC�UIN Date: _��2�j2�?:��:� __ <br />DEPARTME.IV-1- OF PULIC WORKS <br />Received By: � Vl� <br />Df�GVEWAI��� AI�f D f�'AVF_D 1=FtC31d'i"A,CTE <br />PE1�1141T APPLICATI�Id CRf�:_ U!D �} "7'7.,x" <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right=of-Way on the <br />side of approximately feetlmile <br />of , by installing <br />commence on or about <br />for approximately <br />days. <br />Wark will <br />UVill this protect be sett-mstalled�� _�t� Nu contractors license _ r <br />P:IENCRCACHtdENTSWasler Forrns-TemplalzslEIJCRDACHhIEMT PERMIT DRIVEIV.4Y.doc (08108) <br />OFFICE USE ONLY <br />PPLICANT <br />Name: <br />��N1Y39 <br />1rY1 � �"� 2/ <br />Address: <br />DRIVEWAYS: <br />� <br />r. `� � � ��- C.% <br />Cit ,State, Zi <br />Code: <br />�6 f,�`�� c E� ���/ " <br />Area Code -Tele <br />hone <br />Number; ,Gc9 . 1 � /.� �f �, <br />NOTES; <br />SITE <br />INFORMATION: <br />Parcel Owner's Name: <br />- !mow 1 U ��� � �lC�' <br />Site Address: <br />l G' ,S' `it.�'' � f S "' <br />Cit ,State, Zi <br />Cade: <br />�' �'�J �' G�� R,/ PSz.� � <br />Area Code -Tele <br />hone <br />Number: .Za°> % -- j �Yv <br />RIW <br />CONTRACTOR <br />Name: <br />,A-f!� <br />!1-e' � t�> <br />Address: <br />5-� �.�'t! <br />Cit ,State, Zi <br />Code: <br />�' �C��P'�-7`�'" � � �f �� <br />Area Code -Tele <br />hone <br />Number: �-e�i � , "` �'� <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right=of-Way on the <br />side of approximately feetlmile <br />of , by installing <br />commence on or about <br />for approximately <br />days. <br />Wark will <br />UVill this protect be sett-mstalled�� _�t� Nu contractors license _ r <br />P:IENCRCACHtdENTSWasler Forrns-TemplalzslEIJCRDACHhIEMT PERMIT DRIVEIV.4Y.doc (08108) <br />OFFICE USE ONLY <br />JOB #: <br />'11005 ISSUE DATE: <br />APN �71.2^�c>,-fS <br />FEE DUE: <br />EXP, DATE; <br />DRIVEWAYS: <br />STREET: - <br />�' <br />AREA: �r�ck:zs� <br />QUAD �„a; <br />TYPE: �✓ <br />�,rggp�[ <br />FORNIS: <br />NOTES; <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL; <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right=of-Way on the <br />side of approximately feetlmile <br />of , by installing <br />commence on or about <br />for approximately <br />days. <br />Wark will <br />UVill this protect be sett-mstalled�� _�t� Nu contractors license _ r <br />P:IENCRCACHtdENTSWasler Forrns-TemplalzslEIJCRDACHhIEMT PERMIT DRIVEIV.4Y.doc (08108) <br />