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COUNTY OF SAN JOAQUIN Date: <— / �0 / J7 <br /> DEPARTMENT OF PUBLIC WORKS Received by%�� <br /> � <br /> DRIVEWAY AND PAVED FRONTAGES cR# 0 3a aQ <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE / / <br /> Name APN 141 -.ZY( - /Z FEE DUE rl <br /> EXP.DATE DRIVEWAYS: <br /> STREET /VDrrasa•r, Aue <br /> U 1 ,lm c.&Apv, QUAD A S� <br /> City,�tate-Zip I TYPE 0Ui f <br /> 1 ►1 QJ Le, FORMS <br /> (ArCode)Telephone -� NOTE <br /> e <br /> SITE INFORMATION <br /> n.,..... � :=x;k. �. .. . <br /> P cel Owne Mame /Voff' <br /> �►�Z(� /J � 0IX/iS4i A <br /> DRIVEWAY <br /> City, tate-Zyp��o�e,_ � TYPE QUANTITY WIDTHS <br /> GN , (;1 AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> 2—on— ZS 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 or/* side of 6rri."7ell, <br /> City,State-Zip Code approximately ded/mile EL.-_A of 6wcis Sf <br /> by installing tw to <br /> i <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 /> Access\Per AppTorm\DrivewayPaved frontage <br />