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COUNTY OF SAN JOAQUIN Date:_/ <br /> *PARTMENT OF PUBLIC WORKS . _Received by <br /> RiVEWAY& PAVED FRONTAGES CR# <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> Name JOB 11005 ISSUE DATE / :/ <br /> el vz AP N e.,.. . . <br /> FEE DUE <br /> Address EXP DATE':.'. # g DRIVEWA S <br /> STREET ,;` ... <br /> City,State-Zip Code ., <br /> AREA -✓ �f.z/ QUAD Cx �t <br /> TYPE., 7. E"r .. .:.... .::.... .. . • <br /> (Area Code)Telephone FORMS-,.� <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 @ 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 Highway Right-of-Way on the - i'5�— side of <br /> 'telAveapproxim t y <br /> (Area Code)Telephone r' e / Ce ofcv e-rq '5 <br /> L i'✓1 e /, by installing <br /> Work will commence on or about / 9 2 for approximately /a days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractors License <br />