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COUNTY OF SAN JOAQUIN Date: S l <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# C) <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> S IA ro n sio kez JOB# 11005 ISSUE DATE; <br /> Nam APNIU-I _ I I- FEE DUE <br /> -71 3 Co-rt)) I n q � EXP.DATE DRIVEWAYS: <br /> 11 '' w,^ Addressnn STREET <br /> W <br /> d by Id `15�` �e/ QUAD <br /> City,2tate-Zip Code TYPE w ` <br /> FORMS T�2 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION /Vo <br /> mi Sonim S ))kes �ust ' <br /> Par lOwner ame <br /> w E� ► . <br /> Site Address <br /> q SOS L4.-)- DRIVEWAY <br /> Ci ,State-Zip Code TSE QUANTITY WIDTHS <br /> �, -� '_Q S ) S AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <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 " f 5 side of z f d <br /> City,State-Zip Code approximately I S00 e mile t] of <br /> by installing D VV <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 AppTormOriveaayPaved frontage <br />