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COUNTY OF SAN JUAQU1N ....� - <br /> n DEPARTMNT OF PUBLIC WORKS Received by <br /> E <br /> CR# 0 fo rq <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#1u1�005 � ISSUE DATE / / <br /> N , <br /> a /Cv S G 2 APN DATE r.�v -� FEE DUE <br /> DRIVEWAYS: <br /> Address STREET nilvn�. i fir , <br /> 132 A/ol /GG w AREAf QUAD' <br /> city,State-Zip Code TYPE <br /> S�d cV"0,,✓ Z FORMS 5 i . /7 <br /> (Area Code)Telephone OTE <br /> lZo 9z �9 e <br /> SITE INFORMATION <br /> // Parcel Owners Name <br /> �v dr f1�ii vc2 � �---(arlUs G,.o <br /> Site Address DRIVEWAY <br /> Z /✓ /l `J TYPE QUANTITY- WIDTHS <br /> City,State-Zip Code GRICULT IM @ FRONTAGE <br /> .7 e/ low c,9 q 5 Z d �zullv>ERCIAL <br /> (Area Code)Telephone INDUSTRIAL R/W <br /> (zo9 �j22 RESIDENCE <br /> Zoe _10 66 q,3 <br /> CONTRACTOR PAVED FRONTAGE <br /> GTFi Ft X WIDTH: It <br /> Name <br /> Address The undermgned bmby applies for permission to encroach on County highway <br /> Right-of--Way on the c Sr . side of INV"A/ AYE`. <br /> City,state-Zip Cock approximately 'bf <br /> 7S /-wig '�• �' �'f�i9�¢lfS <br /> by installing !�'.0 <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 /> AccmkPer AWTormOrivewayP_aved&+outage <br />