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COUNTY OF SAN JOAQUIN Date: S /29417 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 6523c� <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNUT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> 5 OF _71 S 0 NJ JOB# 11005 ISSUE DA'],'k / I <br /> Name APN 117 - 17.0 FEE DUE PP/T<—> <br /> S�b gMy( <br /> C7—, EXP.DATE DRIVEWAYS: <br /> Address Ct Z3 STREET <br /> � G — <br /> r'RE GFF Cn CAC' ! �w QUAD S C- <br /> C <br /> a C' ,State- p Code TYPE <br /> CZo J> Q 3 -- fb (2• FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> '0�(=� LV hf C>80NA. <br /> Parcel Owner's Name <br /> C)&-Cbj=tic�1�> <br /> Site Address <br /> M/�I- Cmc Com, DRIVEWAY <br /> r O Ci ,State-Zi Cole TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> 11 (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 dVkt side of I[7or L. 1 2 <br /> City,State-Zip Code approximately &z.)O ee /mile s of 6_ fycvv 1 �.�{ ��,j <br /> by installing �AJ <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 /> AccesslPer App\FormTTivewayPaved frontage <br />