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COUNTY OF SAN JOAQUIN Date:/ /q/_U <br /> DEPARTMENT OF PUBLIC WORKS Received by��— <br /> CR# 0 `33 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATB <br /> /J�};ame APN 1 v l -260 -3 FEE DUE�;>'� <br /> LA le PC v1 "L' M 4 EXP.DATE DRIVEWAYS <br /> 3 Address STREET <br /> 7 <br /> -�= G S/ Suck fog QUAD A15 <br /> City State-Zip Code TYPE ,ou.y <br /> [' - - FORMS_ <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION //a <br /> PUCIP1 Owner's Name <br /> 1<;+e,2L-N C'> 4-le-/vim <br /> Site Address <br /> 5, 67 E Ft)124) 00 DRIVEWAY <br /> City,State-Z ip Code r TYPE QUANTITY WIDTHS <br /> CX 1 S-L( AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone CONIlviERCIAL <br /> INDUSTRIAL @ R/W <br /> 2�� RESIDENCE X <br /> ?Y7 2 kv 6 <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Nam _p <br /> dress The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the A/orM side of 0ek"31 �Z4 <br /> City,State-Zip Code approximately 700 Jee /mile We-v,4 of <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 /> AccessTer AppTormOrivewayPaved frontage <br />