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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by ,e.6 <br /> DRIVEWAY AND PAVED FRONTAGES CR# <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> ame APN 114 - b ( - 1P, FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> / Address U STREET_ S 3n 4 U 1 n e / <br /> 6Q <br /> '&2 )-,N SfocKfon QUAD <br /> y c� ,S ate-Zip Code TYPE <br /> CA FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION Np /0/PC <br /> cel is Name <br /> r r� � <br /> Site Addresk �- <br /> -a DRIVEWAY <br /> .� Ci St t -Zip Code TCQUANTITY WIDTHS <br /> FROTAE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ glair <br /> Z-6 713 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 45a s f- side of_anau1 n e-`2/ L/2 <br /> City,State-Zip Code approximately Soo (Set mile Nyrfh of 01 s f!e d oe <br /> by installing D rivtcvau <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 /> Aocess\Per AppTormlDrivewayPaved frontage <br />