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COUNT.Y U.r SAN JUA(,!U.Lr i <br /> DEPARTMENT OF PUBLIC WDRKS Received by- ' <br /> DRIVEWAY AND PAVED FRONTAGES CR#— <br /> PEI MIT APPLICATION <br /> !ICA7N7T / ;(0�1� OFFICE USE ONLY <br /> Name JOB#11005 ISSUE DATE <br /> DATE FEE DUE U <br /> DRIVEWAYS: <br /> SIREET-"_� <br /> !� City,State-Zi Code TYPE s`�oc.E•72�A.) QUAD � s <br /> (Area Code)Telephone / 0 S -/7 ; <br /> TE ------------ <br /> S INFOR TTOI�, P!A <br /> Parcel Ownct's Name <br /> (_ jSite Address <br /> DRIVEWAY <br /> City, tato-Zip Code TYPE QUANTITY- <br /> WIDTHS <br /> UA Y <br /> �)� C}RICULTURE WIDTHS <br /> (Area Code)Telephone COMMERCIAL @ FRONTAGE <br /> IDENCEy @ <br /> CONTRACTOR' ' <br /> PAVED FRONTAGE <br /> N = GTn Ft. X WIDTH:- <br /> Address <br /> IDTfLAddresa The undersigned hereby applies far <br /> permission to ep �,Highway <br /> on the S' side of E ��,,- <br /> City,State-Zip Code <br /> approximately SZS mile—& <br /> -- by a Of iruD�4LA <br /> (Area Code)Telephone <br /> wilt commence on or about <br /> for Work <br /> approximately <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? <br /> NO YES Contractor's License <br /> ElooeaslPer ApPlFamlDrivewayPaved Eraatage <br /> t <br /> � 0 <br />