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l J <br /> COUNTY OF SAN JOAO'JIN <br /> Date: <br /> DEPARTMENT OF PULIC WORKS Received By: �— <br /> DRIVEWAYS AND PAVED FRONTAGES CR# 13 W7 <br /> PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> APPLICANT <br /> '" JOB#: 11005 _ ISSUE DATE. __ <br /> Name: C-' , : /� t FEE CUE. <br /> Address: ! '1 7„' ' t- ��, APN /SIS-d0_0- <br /> Cit ,State,Zip Code: I EXP,DATE: DRIVEWAYS: <br /> Area Code -Tele hone Nu ber: STREET: ��-_ ------- <br /> SITE INFORMATION: AREA: LI�VDE t�� QUAD <br /> TYPE: -- <br /> Parcel Owner's Name: FORMS: ---------- <br /> Site Address: "? NOTES: — <br /> Cit , State.Zip Code: IV C�f <br /> Area Code -Telephone Number: DRIVEWAY QUANTITY - <br /> TYPE: ANTITY WIDTHS <br /> C NTRACTOR SFR ONTAGE <br /> AGRICULTURE: <br /> Name r �� COMMERCIAL: -- --- <br /> Address- <br /> INDUSTRIAL.: @ RIUV <br /> _ - ---- <br /> FCity <br /> , State,Zi Code: — — <br /> Zip ---- --- --- RESIDENCE: - <br /> Area Code -Telephone Number. <br /> PAVED FRONTAGE <br /> Ft. X WIDTH: Ft <br /> LENGTH: -- <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise enc oath on County sway Right-of-Way on the <br /> �nu,,eQAy 4D, approximately�— r {e�/mile <br /> side of Iv[ by installing — -------- <br /> of 1�✓ --- — _ ------ -- <br /> ----------- ----- —_ — Work will <br /> —---------- <br /> --- --— for approximately days <br /> commence on or about- __ ------ <br /> KETCH (Separate sheet may be submitted) <br /> II <br /> II <br /> �' II <br /> II <br /> it <br /> II <br /> i <br /> Will this project be self-installed? YES <br /> NO Contractor's License <br /> P� z <br /> M CENTRP.LSE VICE-•,�LER'�CAL FJd-SI IJK'.VAS TER.PS ENCROACHMENT PEP.MIT DRIJEWP.Y DO'_ �'3,C9 9 <br /> e.�r <br />