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COUNTY OF SAN JOAQUIN Date: 3 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# a <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNHT APPLICATION <br /> .APP ANT OFFICE USE ONLY <br /> SlIzan, E JOB# 11005 ISSUE DATE <br /> Name APN ZJ/ - /y0 _ FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> 2 I STREET MPIIo A.fKue <br /> 3 " <br /> g 1 Dof _QUAD_S <br /> City,State-Zip Code TYPE w <br /> FORMS_, S/6uc� <br /> (Area Code TelephoneL L OTE <br /> SITE INFORMATION AIC) p <br /> Parcel er s N e <br /> S'.1 f,Address <br /> M E�1 Z� V r D PRIVEWAY QUANTITY WIDTHS <br /> Cityet e-Zip Co 3 AGRICULTURE @ FRONTAGE <br /> ` C n C i COM1viEERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> 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 /> 1 I i „u <br /> Right-of--Way on the ,�lo r.b'� side of <br /> State-Zi Codapproximately y feet/�mi)e% aA e= T” of <br /> City, p e by installing <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 AppTormOTivewayPaved frontage <br />