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COUNTY OF SAN JOA UIN <br /> DEPARTWNT OF PUBLIC WORKS Raeceived by�_ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> f <br /> #11005 ISSUE DATE <br /> Name L�- 1-ZO- Z-S'DATE FEE DUE <br /> Address EET DRIVEWAYS: <br /> �,,., " Tu 2N P,�� Rp. <br /> y,Stats� -�'T en. )0 l�1 QUAD WCrty,State-Zip Code E Gc.JMS55(Area Code)TelephoneE <br /> Zc�9 - 40/-z99/ <br /> SITE INFORMATION <br /> Pl' s Name <br /> 3 c� Site Address <br /> Sal+ ��h pt L'C� /, [D� VEWAY <br /> City,State Zip Code E QUANTITYTHSRICULTURE@FRONTAGE <br /> (Area Cor Telephone MMERCIAL <br /> INDUSTRIAL @�— <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name <br /> LENGTH. PAVED <br /> X WIDTH: Ft. <br /> ,.� <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the Eq side of <br /> City,State-Zip Code approximately f�770 5a of <br /> A ,by inst �— <br /> (Area Code)Telephone <br /> -------------- <br /> will commence on or about for approximately Work <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> this project be self-installed? NO YES Contractor's License <br /> Acce-Tar App\FOr-Oriv—y.Paved ft+oatage <br />