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COUNTY OF SAN JOAQUIN Date: 3 / 09 / 0 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by - <br /> CR# 0 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATF, lC 3 /C <br /> Name APN��3 U -1U FEE DUE <br /> EXP.DATE 01-1^0.2-Ocd DRIVEWAYS: <br /> _--Address STREET a r <br /> 15 ) W, k a ct do� cam. QUAD �(w <br /> City,State-Zi Code �� 5–.Z Z TYPE c-sa <br /> — k� ` L 4, FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION 4/2 S <br /> Parcel/Owner's Name / <br /> Sit:Address DRIVEWAY <br /> 2 -Z -7 J5-;, 7N� �`�Ce �C TYPE QUANTITY WIDTHS <br /> Coity,State-Zip Code SZ Z u AGRICULTURE @FRONTAGE <br /> g COMMERCIAL(Area Code)Telephone INDUSTRIAL @ <br /> RESIDENCE X <br /> CONTRACTOR PAVED FRONTAGE <br /> 6k yiz� 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 OvVYa _side of f P4u&-1, <br /> City,State-Zip Code approximately $Dy 1(0/mile Lues of <br /> gewdes- <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 Apff otm\DrivewayFaved fromtage <br />