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COUNTY OF SAN JOAQUIN Date: lO 17 l 07 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# 0 3 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> DA <br /> e FEE DUE�TTD- <br /> / / <br /> rOomEXP.DATE DRIVEWAYS: <br /> dress !' STREET 6,Qai2 <br /> I' QUAD S <br /> City,State-Zip C&e TYPE 7�y✓ <br /> C, �2-C, -20 FORMST� 17 <br /> (Area Code)Telephone NOTE <br /> 9 <br /> r^ r� SI INFORMATION Z 4 YDS a <br /> r, SQ `) i <br /> Parcel Owner's Name <br /> Site Addre <br /> �C��asl C CJS^ �2- DRIVEWAY <br /> _ City,State-Zip Code TYPE QUANTITY WIDTHS <br /> ©c G c3 ? 2 !� 3 q AGRICULTURE @ FRONTAGE <br /> t `(TAre-aCod Teleplionnee COMhIERCIAL <br /> INDUSTRIAL @ RAV <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 CQU side of <br /> City,State-Zip Code approximately /S06 eet mile Lg S t— <br /> by ins;tallfng <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\FormOrivewayPaved frontage <br />