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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> ]DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE 1 I <br /> Name APNU2-5 - X60- FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> 'L ? ® �✓,V P QUAD—gAaL <br /> City,State-Zip Code TYPE D�.✓ <br /> CA FORMS lrywr 1 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION NO <br /> Parcel Owner's Name <br /> ,,Site Address <br /> L � S�� of r L t4 DRIVEWAY <br /> City,State-Zip Cade TYPE QUANTITY WIDTHS <br /> LC- 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 fo,pe n�ssion to encr ch on County In way <br /> Right-of-Way on the �.S i'/VO "'side of_ A r t" <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 /> AccmTer App\FormTrivewayPaved frontage <br />