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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> cR# D 3 f x'33 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB'.#.,,1�1005 ISSUE DATE <br /> Name APlq� -J 29 - ZB FEE DUE <br /> 6'aw0 w F!a� '4q EXP.DATE DRIVEWAYS: <br /> Address STREETGf ' <br /> B ( A-) 'TC-11v Yc o- AREA <br /> - QUAD A)C. <br /> City,State-Zip Code TYPE <br /> FORMS <br /> 6 (Area Code)Telephone OTE <br /> "3 b2 2 i —0 <br /> 43/ SIS O ON <br /> `rte <br /> Parcel Owner's Name <br /> -7 zy lseac <br /> Site Address <br /> C 'T 9'� -j-y `i DRIVEWAY DQUANTITY WIDTHS <br /> 1 <br /> Ci),State I Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Ara Code)Telephone INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> unty <br /> Address The undersigned hereby applies for permission to encroach on C Highway <br /> Right-of-Way on the Pg&� side of laecahe <br /> City,State-Zip Code approximately_Q.2�_feet I $i�1i of <br /> ,by installing 0r,-0 a is&cf <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 /> AccmTer AppTorm0rivewayPaved frontage <br />