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COUNTY OF SAN JOAQUIN Date: 9 //4f /Z°G 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by_— <br /> DRIVEWAY AND PAVED FRONTAGES CR# D ::5 f> <br /> PERNUT APPLICATION <br /> AL� (� CANT�' LIOFFICE USE ONLY <br /> Um n 6Gr V,AJOB# 11005 <br /> ISSUE DATA <br /> Name _/ <br /> APN I ZZ - 040 - o4 FEE DUE_P/PO <br /> �35� �/Jl✓ham fv�l EXP.DATE DRIVEWAYS: <br /> � <br /> Address <br /> 1. � STREET WAGGE2. RP, <br /> ` `ulrarnGt��a GGt 5Tock7rs&_7 QUAD + <br /> City,State-Zi Code <br /> 15 TYPE 1.t.J s <br /> xx�� FORMS_�5 ww, ,Q/7 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION eS <br /> Parcel Owners Name <br /> ddre <br /> Gj, DRIVEWAY <br /> \ City,State-Zip Code TYPE QUANTITY WIDTHS <br /> /--,, f�s'a _ AGRICULTURE @ FRONTAGE <br /> (Area CCoode)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE kc-- <br /> CONTRACTOR <br /> c/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 ,r a7% side of <br /> City,State-Zip Code approximately 90o /mile 141,.r,(- of 99 9" <br /> by installing Rol' <br /> (Area Code)Telephone <br /> will commence on or about for approximately days, Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AccessTer AppTormOrivewayPaved frontage <br />