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COUNTY OF SAN JOAQUIN Date:41 / 2 04 <br /> /d 7 <br /> DEPARTMENT OF PUBLIC WORKS Received b <br /> CR# o0 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE/ <br /> Name APN 2Z6 - - FEE DUE <br /> ? ,r/ AR--nc EXP.DATE DRIVEWAYS: <br /> ddress STREET 2S <br /> Imo. -MAecal QUAD <br /> City,Stat -Zip Code TYPE G✓ <br /> �� FORMS lvw — <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION NO <br /> Parcel Owner's Name <br /> VSe Address DRIVEWAY <br /> X&P• TYPE QUANTITY WIDTHS <br /> City,State-Zip Code <br /> ! � AGRICULTURE @FRONTAGE <br /> 4 � <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 side of <br /> City,State-Zip Code approximately feet/mile of <br /> by instg <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 /> Aaess\Per App\Form\DrivewayPaved frontage <br />