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Sefp- Ke4^S. COUNTY OF SAN JOAQUIN Date: <br /> C!!o �.1 b--vIetl" 'PARTMENT OF PUBLIC WORKS Received by �i-P <br /> DRIVEWAY& PAVED FRONTAGES CR# a 6 e 751 <br /> PERMIT APPLICATION <br /> APPLICANT <br /> II ; 0FF.ICE:`USE>ONLY <br /> oher _ <br /> JOB#11005. ISSUE DATE / <br /> r APN FEE DUE <br /> ' EXP DATE DRIVEWAYS. <br /> �cogt© � � STREET I <br /> City,State � .oda AREA <br /> � L <br /> { <br /> TYPE flr<�+ . <br /> (Area Code)Telephone FORMS <br /> NOTE <br /> SITE INFORMATION <br /> r DRIVEWAY <br /> _ r T v 1 �,.,., .t �1 TYPE QUANTITY WIDTHS <br /> C AGRICULTURE @ FRONTAGE <br /> City, <br /> State- ip tvuc COMMERCIAL <br /> INDUSTRIAL @ RNV <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> 5amf a5 S;�e <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> city,Slate-Zip Code on County Highway Right-of-Way on the Scx. side of <br /> 'J;"N'A approxim ly <br /> (Area Code)Telephone o o et ile-W-f5+- of S <br /> by installing <br /> 0 w.c�4.rr-- <br /> Work will commence on or about J� O for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br />