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COUNTY OF SAN JOAQUIN Date:/u /!`� <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0 <br /> 5 )7A; <br /> ]DRIVEWAY AND PAVED FRONTAGES <br /> PERNHT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> ���,�,/ JOB#11005 ISSUE DATE <br /> LkTTF,-p '/_ T e ,�S��C ���r"I MI� �N�-Z�� - � FEE DUE EXP.DATE DRIVEWAYS: <br /> STREET a iA V6 <br /> 7 (� l JAREA <br /> ~ a c jc T o:�7 QUAD <br /> City,S�Zi .Code / TYPE `Z�w, f <br /> ( C�c3� , 9 FORMS`y L��y, A!-/7 <br /> (Area le hone NOTE <br /> SITE INFORMATION <br /> arcel Owner's Name <br /> Site�c�j����((jjress� <br /> � DRIVEWAY <br /> fi <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> �C I/ 4:�j AGRICULTURE @FRONTAGE <br /> (Area ode)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the iT side of AOc- <br /> City,State-Zip Code approximately 2-exD ee -m-* of <br /> ,by installing <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Accm\Per AppTor&DrivewayPaved frontage <br />