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COUNTY OF SAN JOAQUIN Date:: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# o S 73 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005� /�,' ISSUE DATE Name APN 111 - { FEE DUE <br /> /�� �/ '/�i � d✓( EXP.DAT DRIVEWAYS: <br /> ddres / STREET <br /> C)lv771 f t ��,,�l�t QUAD <br /> City tatf�Zip Code , TYPE a o s <br /> 4X 11 t�/k ti l.4 FORMS j W <br /> ade)Telephone NOTE <br /> SITORMA ON <br /> Parcel Owner's Name <br /> Site Address <br /> (1G± DRIVEWAY <br /> (ti State-Zi Code TYPE QUANTITY WIDTHS <br /> ate32 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 �A/a e f= side of `, b i, S'¢ <br /> City,State-Zip Code approximately S;--x) Leet mile ('31,4y k 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 /> Access\Per Apfform\DrivewayPaved frontage <br />