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COUNTY OF SAN JOAQUIN Date: / ��• /, L_ <br /> ' ARTMENT OF PUBLIC WORKS Received by <br /> 6RIVEWAY& PAVED FRONTAGESo 0 <br /> CR#__ ¢ Z4- <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY , <br /> Name JOB#11005 ISSUE DATE <br /> FEE DUE <br /> Address EXP DATE }" „ DRIVEWAY <br /> IsTREET,02.2, <br /> City,St e-Zip codeAREA �r ::QUAD ;+ ,;: ... <br /> TYPE <br /> (Area Code)Telephone FORMS .,.. .''�.. . <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 1VFsr— side of <br /> Tu�L ,eo approximately <br /> (Area Code)Telephone soao eet mile out/ of L/s�'V�y L.v. <br /> by installing <br /> Work will commence on or about1r for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractors License <br />