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COUNTY OF SACT JOAQUIN luxe: A 0(,> <br /> DEPARTMENT OF PUBLIC WORKS Received by-,7,25-- <br /> Cit# 0? <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> - APPLICANT OFFICE USE ONLY <br /> 1�tlrr/l in l`/Il 12f!=-LO JOB#11005 ISSUE DATE <br /> Name APN ly - Z561 - FEE DUE#180.qv <br /> O E)CP.DATE DRIVEWAYS: <br /> Address / STREET FG;=DO e^ XD. « <br /> c-�4-i� �7 o2�v`i r-iee 1. fj cAMP _QUAD -5 F- _ <br /> City,State-Zip Code TYPE slry « <br /> FORMS 55 tuLv; ,t? 17_- -- -- <br /> (Area Code)Telephone NOTE —� <br /> ttlo I'iF� <br /> SITE INFORMATION <br /> A-C-,UI <br /> Parcel Owner's Name <br /> Site Address <br /> G `���� C. DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> VNDUSTRIAL @ R/W <br /> rIDIRICE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIE 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_A/d K side of FE2X)Y9_ pAnn <br /> City,State-Zip Code <br /> approximately CSO mile ET a+�'(' of r94Z" <br /> .by hwtalhng -bVD. <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 /> A==\Per ApplFormlDrivewayPaved fiadage <br />