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COUNTY OF SAN JOAQUIN Date: 7 <br /> DEPARTN ENT OF PUBLIC WORKS Received by �- <br /> CR# 0 32-7,52 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DA� <br /> L C jNamAPN D SI - /570 - 65' FEE DUE M <br /> eEXP.DATE DRIVEWAYS: <br /> Address STREET_ 02:rr Q.D <br /> to K , rig .2 S AREAGoe QUAD E <br /> City,State-Zip Code TYPE ` <br /> 20 q - q C1 ]j '7 2 2<a FORMS5 1 r)-V 12 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION ,- AlO f vp c <br /> ck <br /> Parcel is Name <br /> Site Address DRIVEWAY <br /> - C ', J , C c? TYPE QUANTITY WIDTHS <br /> ` City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> 2 �• COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> 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 ua ti side of AY24lol <br /> City,State-Zip Code approximately n eet mile tin of �t�e w <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 AppTorm\DrivewayPaved frontage <br />