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COUNTY OF SAN JOAQUIN Date: _/ <br /> DEPARTMENT OF PUBLIC WORKS Received• b DRIVEWAY& PAVED FRONTAGES • CR# Y <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> (C' <br /> Name JOB# 11005 .' ISSUE DATE <br /> APN -J '` .. „ FEE DUE <br /> J Address EXP. DATE_ s D IVEWAYS: <br /> f-IP cot C/°�„ `�SJ�3l STREET. 4U.,s*4t� ' *. i vt c✓� <br /> / City,State-Zip Code AREA QUAD <br /> TYPE <br /> '(Area Code)Telephone FORMS <br /> NOTE_' -t''/ +'ccei hf.v ttit.C �-c �,.°oto.✓ �r�readtr�Jie' <br /> 2-- <,'7el I/,- <br /> SITE <br /> SITE INFORMATION <br /> Parcel Owner's Name _ <br /> DRIVEWAY <br /> Site Address TYPE QUANTITY WIDTHS <br /> �f-1-1,n C A- AGRICULTURE @ FRONTAGE <br /> City,State-Zip—Code COMMERCIAL k <br /> INDUSTRIAL @ R/W <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> City,State-Zip Code on County Hiahwav Riaht-qf-Way on the tVC S f Side of <br /> approximately <br /> (Area Code)Telephone So.1 .p <br /> �, of -�..Y ��� a.c 4t i it Dir Ur'r <br /> by installing <br /> Work will commence on or about for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> w o r -Vf) - j 55 tvl h GP. <br /> Will this project be self-installed? NO YES Contractor's License <br />