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COUNTY OF SAN JOAQUIN Date: d <br /> EPARTMENT OF PUBLIC WORKS , Received by <br /> RIVEWAY& PAVED FRONTAGES CR# cn�)Kcp3� <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> v, l N <br /> Name JOB# 11005 ISSUE DATE <br /> Sal L(/V ,CD APN FEE DUE <br /> Address EXP.DATE 4:- '' DRIVEWAYS: <br /> IT-A C-y CA "1 1; STREETFA T Cz ult l /`✓cw.t <br /> City,State-Zip Code AREA QUAD -;i <br /> TYPE <br /> (Area Code)Telephone FORMS>`/0 <br /> NOTE <br /> SITE INFORMATION <br /> Parcel Owners Name DRIVEWAY <br /> Site Address TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> City,State-Zip Code COMMERCIAL <br /> INDUSTRIAL @ RM/ <br /> (Area Code)Telephone RESIDENCE <br /> ' CONTRACTOR <br /> //- PAVED FRONTAGE <br /> /1�t' Khoa�n q,,L f-IniS "�i�C <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 Highway Right-of-Way on the 1VOK774 side of <br /> FAOW approximately <br /> (Area Code)Telephone feet/inifB S�61&1-rh of M-ET i P-0 <br /> L-AC-G, by installing OtiC7 Sf7rZL D2IVE:,:. AV <br /> Work will commence on or about �—( �- X11 for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br />