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4bi, COUNTY OF SAN JOAQUIN Date: � / J <br /> 0-PARR <br /> TMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY& PAVED FRONTAGES CR# D D <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> Name .....JOB # 11005 / ISSUE DATE <br /> APN FEE DUE <br /> Address EXP'. DATE DRIVEWAYS: <br /> r <br /> c:; :, STREET <br /> City,State-Zip Code AREA QUAD S`.) *o. <br /> TYPE <br /> (Area Code)Telephone FORMS <br /> NOTEz� <br /> SITE INFORMATION c.,, ;;r„ <br /> Parcel Owners Name DRIVEWAY <br /> Site Address TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> City,State-Zip Code COMMERCIAL <br /> INDUSTRIAL @ RNV <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> ./��, PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> A-a L..a'-/C-. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> City,State-Zip Code on County Highway Right-of-Way on the side of <br /> approximately <br /> (Area Code)Telephone U feet>/mile h ✓ of C <br /> /by installing .�2,/ <br /> Work will commence on or about 17 �r ��t for approximately `l"'� days. <br /> SKETCH (Separate sheet may be submitt d) <br /> Will this project be self-installed? NQ YES Contractor's License <br />