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- COUNTY -CSF SAIJOAQUII� <br />DEPARTMENT OF PULIC WORk;S <br />I KWLIN'AY6 ANIS PAftL) HAM,, I AGI'ES <br />PERIIIIIT AFIF L,ICATION <br />APPLICANT <br />OFFICE USE: ONLY <br />Name: <br />11005 ISSUE DATE: <br />e) C.� <br />�,}-�/ FEE DUE: <br />City, State, Zip codes Cj � C A , <br />95 CJ <br />Area Code Telephone Number: e2,1 ('.d <br />SITE INFORMATION: <br />"tyC' Aa V%.. QUAD `5S x <br />Parcel Owner's Name: T. — <br />I p em-. <br />FORMS; <br />Site Address: 6,4 p . . <br />NOTES; <br />city, State, Zi Code:rQ n-� c <br />Q <br />Area Code - Tele hone Number: <br />TYPE: <br />CONTRACTOR <br />QUANTITY <br />Name:_ <br />AGRICULTURE; <br />Address: <br />FRONTAGE <br />City, State, Zip Code: <br />INDUSTRIAL: <br />Area Code - Telephone Number: <br />R/W <br />�t w-1 4; <br />Cafe; �� er- f, ,%,� �.�" <br />- -- <br />Received By. J� - VV <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />SIM of approximately feet/mile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />VVill this project be self -installed? _YES _ _NO <br />Contractor's L-icense <br />P:IENCRONCHLIEIITSIIviasler Furms-ieny�IslaslElwROACHAlE60 'ERIAI�DRIVEWAY.c+x (OOIOBJ - - -- -- - - -- - - <br />OFFICE USE: ONLY <br />JOB #; <br />11005 ISSUE DATE: <br />APN� <br />�,}-�/ FEE DUE: <br />EXP. DATE: <br />_ <br />DRIVEWAYS: <br />STREET:/j9Cl� <br />AREA; <br />"tyC' Aa V%.. QUAD `5S x <br />TYPE; <br />FORMS; <br />NOTES; <br />" <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE; <br />FRONTAGE <br />COMMERCIAL; <br />INDUSTRIAL: <br />R/W <br />RESIDENCE; <br />PAVED FRONTAGE <br />LENGTH: <br />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 />SIM of approximately feet/mile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />VVill this project be self -installed? _YES _ _NO <br />Contractor's L-icense <br />P:IENCRONCHLIEIITSIIviasler Furms-ieny�IslaslElwROACHAlE60 'ERIAI�DRIVEWAY.c+x (OOIOBJ - - -- -- - - -- - - <br />