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COUNTY OF SAN JOAQUIN Date: & /_Z3 / o7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPS ANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE ! ! <br /> r Name APNL- FEE DUE <br /> .2111 , EXP.DATE DRIVEWAYS: <br /> Address STREET Wi/Cum <br /> AREAS Loc/corm QUAD <br /> City,State-Zip Code TYPE 17r.1/2w2q <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATIO /of - � <br /> Parcel Owner's Name <br /> S}'te Address DRIVEWAY <br /> City,State-Zip Code - TYPE QUANTITY WIDTHS <br /> �� AGRICULTURE @ FRONTAGE <br /> S'S�'/`S <br /> (Area Code)Telephone COMMERCIALINDUSTRIAL @ RAV__ <br /> �� �I S�- 'S RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <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 ,Aw, <br /> City,State-Zip Code approximately �'ZDy ee /mile Sa�L, of_ T4 88 <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 ApplFormOrivewayPaved frontage <br />