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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by �a <br /> DRIVEWAY& PAVED FRONTAGES CR# <br /> PERMIT APPLICATION <br /> APPLICANT < ,, <> ;, r . <br /> < ;� s OFFICE USE ONLY : v <br /> Name p JOB#11005 ISSUE DATE / a 1 <br /> SEE DUE <br /> Address _ EXP' DATE <br /> J 3 G STREET <br /> city,State-Zip Code AREA. x <br /> tD�"(Area <br /> �_ Code)Telephone FORMS <br /> • NOTE' �, <;t�: <br /> .. ' <br /> SITE INFORMATION <br /> r <br /> Parcel Owners Name DRIVEWAY <br /> • l 7 QS'f S- j DF--+4� W�4Y <br /> Site Address SFR.KTYPE QUANTITY WIDTHS <br /> r � �� 73—3 3 4 AGRICULTURE @ FRONTAGE <br /> City,St e-Zip Code COMMERCIAL <br /> D Cl r. 3 — � INDUSTRIAL / @ RNV <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> 0<1 4(2-S 14p L- L.=—,4 o2—Name LENGTH: Ft. X WIDTH: Ft. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> City,St le-Zip Code on County Hi way Right-of-Way on the &&S7- side of <br /> �0 q ?-x 3 _ l3, -Zo I b i approximately <br /> (Area Code)Telephone !r O feet I mile &Jv&X& of /5Y/WA-y l <br /> by installing /J RIVEGVl4Y <br /> Work will commence on or about / (q h14r- for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br />