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COUNTY OF SAN JOAQUIN Date:� <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# ©' 0_ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> A�PyT OFFICE USE ONLY <br /> it-^tT lffltc,i(VVA"J JOB# 11005 ISSUE DATE <br /> _ Name t APN FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET +e►�` <br /> (T e i 5 )�,q 7- QUAD F <br /> Ci State-Zip Code TYPE <br /> FORMS 7 <br /> (Area Code)Telephone NOTE Vr"SITE INFORMATION ` e> ,o �2 <br /> / <br /> i Parcel ees e / <br /> Site A dress t DRIVEWAY <br /> TSE QUANTITY WIDTHS <br /> Ci State ZCode�. , , te- ip Z. :y AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W_ <br /> _ RESIDENCE SL_ <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 _c:; f4 side of �neu�� ,ed, <br /> City,State-Zip Code approximately C.;00 dek/mile WPSl- / o1 <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 AppTormOrivewayPaved frontage <br />