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COUNTY OF SAN JOAQUIN Date: :!�- / /�q/ U <br /> DEPARTMENT OF PUBLIC WORKS Received by-3i <br /> CR# (!;' 3 J <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> `A` OFFICE USE ONLY <br /> r— C� (i ( JOB# 11 ISSUE DATE. <br /> Name C��S APN � FEE DUE--- 0 <br /> l�41� (��1 Z-C, C f EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> � . 06-Eb, 77z: 1" QUAD /2 <br /> State- ip Code TYPE 2'G� <br /> FORMS 4-17 Code)T lephone OTE <br /> C20� (-242 <br /> SITE INF RATION <br /> f E7 l�� 1c4�: <br /> Parceler's Name ()� <br /> ani N,J��c2 <br /> Site Address <br /> STyC�L•�^— c� �? DRIVEWAY <br /> City,Stat -Zip Code TYPE QUANTITY WIDTHS <br /> a � d AGRICULTURE @ FRONTAGE <br /> � <br /> (Area Code)Telephone COMIviERCLAL <br /> INDUSTRIAL @ R/W_ <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> 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 e, side of aecch e r 12d. <br /> City,State-Zip Code approximately 0,115 feet mile Ail 4-6 of 06 <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 AppTormOrivewayEaved frontage <br />