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COUNTY OF SAN JOAQUIN Date: / t3 / 17-7 <br /> *EPARTMENT OF PUBLIC WORKS . Received by <br /> RIVEWAY& PAVED FRONTAGES CR# Z <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> COCA e, C©, <br /> —17— Name JOB# 11005 ISSUE DATE <br /> ,�hSJ 'ei,,�kr'tI6 APN V p Z FEE DUE <br /> Address EXP. DATE DRIVEWAYS: <br /> S-( G�f STREET" ' <br /> City,State-Zip Code AREA QUAD-AL <br /> --c>ZyO TYPE w0. rt <br /> (Area Code)Telephone FORMS <br /> NOTE <br /> SITE INFORMATION <br /> Parcel Owners Ni6me DRIVEWAY <br /> Z7 Mt-&w L V(- <br /> Site Address TYPE QUANTITY WIDTHS <br /> 64 AGRICULTURE @ FRONTAGE <br /> City,State-Zip Code COMMERCIAL <br /> 7� '0 d INDUSTRIAL @ R/W <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name T� LENGTH: Ft. X WIDTH: Ft. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> City,State-Zip Code on County Hi hwa Right-of-Way on the ln/eS�- side of <br /> celel A 0 approximately <br /> (Area Code)Telephone M201 e /fig' lA/ of (2�1a)')k'6L (_i/\ <br /> ,, by installing �/1dE't4AL/ <br /> Work will commence on or about for approximately o days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br />