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COUNTY OF SAN JOAQUIN Date: 10 / / 107 <br /> DEPARTN ENT OF PUBLIC WORKS Received by <br /> CR# L? <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE / J <br /> Name APN /�7-,OW- 19_ FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> C _ <br /> Address STREET or W u <br /> AREA /`/ej,i 4 c a QUA _ <br /> City,State-Zip Code TYPE <br /> N, as �,sL FORMS <br /> (Area Code)Tele hone OTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Site Address <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <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 pphes for permission to encroach n County Hi7�/ <br /> Right-of-Way on the T or side of <br /> City,State-Zip Code approximately feet/mile o <br /> Jy <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 /> AccesslPer AppTbrmOrivewayPaved frontage <br />