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COUNTY OF SAN JOAQUIN Dater <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> �7 <br /> DRIVEWAY AND PAVED FRONTAGES cR# o�1'' <br /> PERNUT APPLICATION <br /> �J J , OFFICE USE ONLY <br /> /'7Ti< �it-�'I e JOB# 11005 ISSUE DATE <br /> Name, APN _- ?J -�_ FEE DUE <br /> EXP.DATE DRIVEWAYS: V <br /> Address STREETE.. Lichk+h —4 <br /> Z`z�l%CAlG (i°� GJ-pck-f,9n QUAD s s <br /> City,State-Zip Code % TYPE <br /> yZ/b:zl FORMS_ WIN <br /> (Area Code)Telephone NOTE <br /> SITE INFO <br /> R11c�QMN yes 101101eA�r� a-dZ <br /> Z �J <br /> Parcel Owner's Name �IOfC% iC / mt,51 KmaC azzy -7- o.�s6w <br /> G�^ dd <br /> Ar� <br /> �'fJK� O DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone CONDAERCIAL <br /> INDUS TRIAL @ R/W_ <br /> RESIDENCE ti <br /> II CONTRACTOR PAVED FRONTAGE <br /> 1�P V l G 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 SguAA side of Ei a h�� freP,f- <br /> City,State-Zip Code approximately 400 �mile E'er S�-- of "B " S/-, <br /> 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 AppTormOrivewayPaved frontage <br />