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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by St. <br /> cR# 03 L'2-2 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> Q APPLICANT OFFICE USE ONLY <br /> 6 r>-m — JOB# 11005 ISSUE DATE <br /> Name APN t S4, -lSU - Q6 FEE DUE TO <br /> g q0 cl // ,er, t cl S /k � EXP.DATE DRIVEWAYS: <br /> Address STREET Cwl7A <br /> r✓?q,7 t PCcL &.,(, '?,5-3 3 7 AREA A-640rxeoo QUAD <br /> CityState-Zip Code TYPE OW <br /> Ca 0 g) 1-1 s 6'-,), 116 FORMS � �✓� �P-J <br /> (Area Code)Telephone NOTE <br /> SI INFORMATION <br /> Parcel Owner's Name <br /> rd <br /> Site Address _ <br /> R',7 2 C C,4 f �'f 5 3 7 DRIVEWAY <br /> L \ City,State-Zip Code TYPE QUANTITY WIDTHS <br /> 5-6 _ of 61AGRICULTURE @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 ov�4A side of Veo., ` <br /> City,State-Zip Code approximately 4G2) . e mile_j�/p>gt of_ _ z e , Q! <br /> > Y 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 AppTormOrivewayPaved frontage <br />