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COUNTY OF SAN JOE'^QUIN Date: <br /> Received by_ JW <br /> DEPARTMENT OF PUBLIC WORKS CR#� <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATT <br /> Name-r, APN g l a- d�� - FEE DUE 1W <br /> ynENP.DATE DRIVEWAYS: <br /> Address STRA C L.EM,r-W 7—S QUAD _ <br /> City,S e-Zip Code FORMS <br /> E A _ <br /> 5f tnll�t/. <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Ownces Name <br /> Site Address �y1- DRIVEWAY6 / TYPE QUANTITY WIDTHS <br /> City, tate-Zip Code AGRICULTURE @FRONTAGE <br /> Te one ephCOMMERCIAL <br /> USTR.IAL _T-- R/V�l <br /> (Area ) <br /> IDENCE <br /> C9 <br /> .� �-6 0�'O <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH; Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the EjME' side of 77V/,eJ) S7-- <br /> City,State-Zip Code approximately /30 gfip/mile ,VVA77/ of HWY AA <br /> by installing G V <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Acoess\Per App\Form\DrivewayPavcd fi-a tage <br /> U/ <br />