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r • <br /> COUNTY OF SAN JOAQUIN Date: I <br /> DEPARTMENT OF PUBLIC WORKS Received by 46CR# 05 11 q <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> O s 13 y P A a 111 C 1-e JOB# 11005 ISSUE DATE <br /> �j Nam q APN IV - 036 - 05' FEE DUE <br /> I� -U• G�'' I O E�: EXP.DATE DRIVEWAYS: <br /> dr s �+e STREET Couk TP.4? C_i_Q p <br /> / <> S�Ou�r01J QUAD [L <br /> City,State-Zip Code �, TYPE ruJ`P <br /> Z,=/,I'7 / ` S G�I� FORMS Z F- <br /> (Area Code)Telephone NOTE <br /> I s W� P <br /> SITE RMUORMATION <br /> Parcel Owner's Name <br /> 3 C, ©ud4T/L6� Wgig_ <br /> Site 11!Address DRIVEWAY <br /> ?U�4� C°� �/. <br /> '`(% <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> r INDUSTRIAL @ R/W_ <br /> IcIc/ea RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <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 S"o yM side of 1 '2 /7 Cid &/ 4 <br /> City,State-Zip Code approximately a&M� eet Ln. <br /> mile Elss� of it ini.� <br /> by installing rtv tJwB�. <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 /> AccessTer Apff orm\DrivewayPaved frontage <br />