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COUNTY OF SAN JOAQUIN Date: S'> / /3 io 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by i <br /> CR# c) 31 (n fv <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> �4 r 0 , t t P ! JOB# 11005ISSUE DATE / <br /> _ Name�i APN 11'9 n 7- V�-ot FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET 101,92 g A.e. <br /> 'SitGF X Gy� , �1 QUAD A42 <br /> City,St to-Zi Code TYPE <br /> 06—,9- ?q/7(" FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION AIC) <br /> (� u C-)f (i-f-L_01111 <br /> Parcel Owner's Name <br /> Site Address , <br /> �5 I Z0( /l L� ; �� DRIVEWAY <br /> City,State-Zi Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE _ @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE "" <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby ap lifor rmission to encroach on County Highway <br /> Right-of-Way on the side of <br /> City,State-Zip Code approximately Tes <br /> et e ,x7v <br /> by inst g D wu. <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 AppTorm\DrivewayPaved frontage <br />