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COUNTY OF SAN JOAQUIN Date:Received <br /> � <br /> ARTMENT OF PUBLIC WORKS Received by/ <br /> WIRVEWAY& PAVED FRONTAGES • CR# CD 4:!;:3 6 <br /> PERMIT APPLICATION <br /> APPY CANT <br /> . �. ��4? � Z OFFICE:USE ONLY <br /> 01 <br /> Name JOB#11005 ;. ISSUE DATE ! ! <br /> t) J `S"fi APN FEE DUE <br /> Addres EXP DATE "" DRIVE <br /> WA <br /> ,n ( � 2 Z STREET r <br /> C' <br /> AREA <br /> ,State-Z ° MS e 4UAD_ <br /> i% r� 7Y P "� <br /> Elr'rt'. € fi �1 <br /> (Area ode)Telephone FOR <br /> NOTE <br /> SITE INFORMATION <br /> LbA/&&k Aty +S14&Z y*U <br /> Parcel Owner's Name nn --' DRIVEWAY <br /> 1965 'L ' kk &VC l� <br /> Sae Address TYPE QUANTITY WIDTHS <br /> ply CA AGRICULTURE FRONTAGE <br /> City,State-Zip Code COMMERCIAL <br /> INDUSTRIAL R11N <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> S �� <br /> ILL . <br /> Name LENGTH:_ Ft. X WIDTH: Ft. <br /> Addres ,1 <br /> A <br /> L i A L i �/ �� The undersigned hereby applies for permission to encroach <br /> V <br /> We— <br /> city State-Zip Code on County Highway Right-of-Way on the y side of <br /> IZ,e-e✓& per, approximately <br /> (Area3 Code)Telephone a� feet kR4e �� of n'1 t I� <br /> — by installing 0-116 aT'/�2`'�tG�i <br /> Work will <br /> commence on or about �'�(�f7 for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> Atm su*� co1f_tnctatled? NO __ YES Contractor's License <br />