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COUNTY OF SAN JOAQUIN Date: �, /,??/®7 <br /> DEPARTMENT OF PUBLIC WORKS Received by_= <br /> CR# C)3 z.G C/:3 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERART APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN �W - A - /C� FEE DUE <br /> S/ YLCEXP.DATE DRIVEWAYS: <br /> A�d�ess STREET <br /> l U �nc �rd QUAD �— <br /> City,State-Zip Code TYPE <br /> L b4 95,692- FORMS <br /> (Area Code)Telhone NOTE <br /> SITE INFORMATION !j <br /> Parce Owner's Nar�}e \ / <br /> /So r <br /> Site Adds 0 <br /> b DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> (,4 G ,5 ZZ p 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 side of Le/,er ,2d. <br /> City,State-Zip Code approximately feet/mile of <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 AppTormOrivevayPaved frontage <br />