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COUNTY OF SAN JOAQUIN Date:.] / %b <br /> Received by <br /> DEPARTMENT OF PUBLIC WORKS CRN 0�3 3 i 0 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY I <br /> JOB#11005 ISSUE DATE <br /> FEE DUE <br /> Name APN - I�—-�`' DRIVEWAYS: <br /> EXP.DATE <br /> Address STREET Ia r h %�' dnaG o� - <br /> 1S( 1 .oCge��rrl QUAD N - <br /> XTYPE - <br /> �, City,State- I FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> parcel Owne.s Names r <br /> Siteddre s \e \ DRIVEWAY <br /> 5.7 Y `�, 4 —`_----- TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL @ RIW <br /> (Area Code)Telephone INDUSTRIAL <br /> RESIDENCE <br /> 1-:cam'll y o `t , <br /> PAVED FRONTAGE <br /> CONTRACTOR Ft. X WIDTH: Ft. <br /> LENGTH: <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Highway <br /> Address Right-of--Way on the /y r* side of <br /> approximately-- 5 feet of <br /> City,State-Zip Code ,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 /> Ll this project be self-installed? __NO <br /> YES Contractor's License <br /> Access\per App\Form0nvewayPaved frontage <br />