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COUNTY OF SAN JOAQUIN Date: 5 l AT l D <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 77 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> f JOB# 11005 ISSUE DATE, <br /> Name APNZD7_-3_Z0-0'? FEE DUE S <br /> J�2 S-,�),6 U✓U c C 2 A W C EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> L ,4,<D%LG— 0& 9!5-26/ AREA L%CAGan! QUAD .S <br /> City,State-Zip Code TYPE <br /> FORMS ltJlll, P,/7 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION I 1� ?I F E s <br /> Parcel Owner's Name �I 1 <br /> Site Address DRIVEWAY <br /> AIM( 1_5i- t4- ",G 7'3"Z 0 O'F TYPE QUANTITY WIDTHS <br /> City,State-Zi Code <br /> �► _,6W (,A /S_21© AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone CONINIERCIAL <br /> NDUSTRIAL @ R/W <br /> �'9 ' .7�/_` 7—� 'k RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereb applies for permission to encroach on ounty Highway <br /> Right-of-Way on the h side of t,7dV — 5 <br /> City,State-Zip Code appr ximately e /mile of d atm .r <br /> by inst <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> —I <br /> 7 1" <br /> Will this project be self-installed? _--NO C YES Contractor's License <br /> AccessTer AppTormOrivewayFaved frartage <br />