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A5/� COUNTY OF SAiV JOAQUIN �j l� 1ZD�D: <br /> G DEPARTMENT OF PULIC WORKS `C" <br /> 3`3 Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATIOM CR#:C'S'L Q 1` <br /> APPLICANT OFFICE USE ONLY <br /> Name: f} <br /> Address: .3 6.e1e1_7e1h-e JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: CA APN �(5 �,c� - FEE DUE: <br /> Area Code -Telephone Number:_->70 - S7 — 07 EXP.DATE: DRIVEWAYS: <br /> STREET: (n <br /> SITE INFORMATION: AREA: QUADS - <br /> Parcel Owner's Name: ALaqgv J- Bey Wd t't e' TYPE: <br /> Site Address: 1,1' ex*rn FORMS: S _ <br /> ► <br /> City,State,Zip Code: e5cu/ e' NOTES: <br /> Area Code -Telephone Number: Q/y d <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: 5 Ch h 1 C,. AGRICULTURE: @FRONTAGE <br /> Address: 300 COMMERCIAL: <br /> City,State,Zip Code: �� C ys3 INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number. �X — �� (a 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 Ri ht-of-Way on the <br /> K. ls+ s' e of__s �ti _approximately ee ile i <br /> by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Af, Will this project be self-installed? YES NO Contractor's License <br /> M.\CENTRALSERVICESICLERICAL\PUB-SV.WKIMASTERPSIENCROACHMENTPERMIT ORIVEWAYAOC (C9113) Page Iof2 <br />