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COUNTY OF SAN JOAQUIN Date:_�_�____ <br /> Received by�_ <br /> DEPAR'T'MENT OF PUBLIC WORKS CR#ter , 3t6� 3 2C� <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APP CAuT OFFICE USE ONLY <br /> 70B#110 5 ISSUE DATE <br /> A 'Ct -A o 1- 0 �? FEE DUE <br /> Nnme API- O -�— DRIVEWAYS: <br /> y� tri 5 EXP.DATE „ <br /> Address+ STREET QUAD <br /> Citv,$.tate-Zi Code 8 rORMS � ) — <br /> Cy�vIk 1�0 `1(Area Code)Telephone <br /> G y14- zz9 <br /> SITE INF TION <br /> ,30, ' ✓a <br /> Parcel Owne s Name <br /> A �f (� ✓ a ovl5 • Kms• <br /> Si e A ess n DRIVEWAY WIDE <br /> U tV \`� TYPE QUANTITY <br /> ------------ <br /> City State-Zip Code GRICULTURE @ FRONTAGE <br /> � O <br /> i✓& COMMERCIAL <br /> (Area Code)Telephone USTRIAL @ R/W <br /> g 3O v SIDENCE <br /> PAVED FRONTAGE <br /> CONTRACTOR . X WIDTH: Ft. <br /> ECT7TH--:—:----jt <br /> Name <br /> The undersigned hereby applies for permission to encroach on Co <br /> ad unty Ighway <br /> Address Right-of-Way on the side of r <br /> Of <br /> approximately 00%So_feet <br /> City,State-Zip Code �by install n <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> SCC a�SC � atiI VeAvv <br /> Will this project be self-installed? _ _NO <br /> X YES Contractor's License g <br /> Access\Per ApplForm\Drivewaypaved frontage <br />