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COUNTY OF SAN JOAQUIN Date: / /�/07 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# <br /> PERNM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN <br /> 63 FEE DUE <br /> EXP.D1ATTE- DRIVEWAYS: <br /> / A s �. ,� <br /> S ��aYt QUAD E s <br /> City State-Zip Code TYPE Qo t vtcway <br /> q-� (.)U FORMS 5-5Z"uw 9-/7 <br /> (Area Code)Telephone y NOTE <br /> SITE INFORMATION yds ��� <br /> Q s c.4.5 <br /> Parcel ner's T&de <br /> Site Address <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRCTOR PAVED FRONTAGE <br /> 0-La-&-f­ 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_ side of inku(- <br /> City,State-Zip Code approximately l q0 eet mile Vis._ of Q41 fts <br /> Auenue >by inst g Oti"wa4 <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 /> AccesslPer Apfform\DrivewayPaved frontage <br />