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COUNTY OF 5AN JL),zUUlly . "C"• <br /> Received by <br /> SARTMENT OF PUBLIC 'Y ORKS ��(� 5'l�y <br /> DRIVEWAY & PAVED FRONTAGES CR#_ <br /> Fes' PERMIT APPLICATION <br /> 7APPLICANT " <br /> OFFICE USE ONLY <br /> JOB #11005 ISSUE DATE l I_ <br /> Name C- 01\3T APN -�ya FEE DUE .. . <br /> EXP,:DATIE DRIVEWAYS <br /> Address ) <br /> CA S2so <br /> AREA QUAD <br /> City,State-Zip Code <br /> FORMS <br /> (Area Code)Telephone <br /> NOTCLL <br /> SITE INFORMATION <br /> DRIVEWAY <br /> Parcel Owner's Name <br /> Gl-{ WIDTHS <br /> sRe Address TYPE QUANTITY <br /> S�GtGTO GA (::'I (IC <br /> AGRICULTURE @ FRONTAGE <br /> City,State Zip Code '- COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Sit✓ � <br /> Name LENGTH: <br /> P�1`1 Ft. X WIDTH: Ft. <br /> Name <br /> Address <br /> s.��C +t side of <br /> <�r a aSZp3 The undersigned hereby applies for permission, o encroach <br /> C A'stat Code on County Highway Right-of- ay on the ` approximately <br /> of <br /> ift- of <br /> (Area Code)Telephone r rye rA� <br /> by installing P <br /> Work will commence on or about I _ _for approximately 3 0 days. <br /> SKETCH (Separate sheet may be submitted) j v <br /> o j I I <br /> MICHAff <br /> N <br /> 1�ri--• <br /> LAUREL ACRES <br /> �• 'j w $CAL[ 0,01 <br /> ® ® <br /> SAN JOAOUIN <br /> TY <br /> A33 SSOK$ MAPS <br /> Will this project be self-installed? NO YES Contractors License ___ <br />