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COUNTY OF SAN JOAQUIN Dater/ 1� /Zo'I <br /> DEPARTMENT OF PUBLIC WORKS Received by 6W <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLIC OFFICE USE ONLY <br /> G AA, JOB# 11005APN ISSUE DATE <br /> FEE DUE <br /> EXP.DAT e DRIVEWAYS: <br /> 1�?d �,5 '� ;�--� STREET cji.f< <br /> AREA <br /> .C�.SfI//rm QUAD S '' <br /> City,State-Zip Code TYPE <br /> FORMS <br /> (area Code)Telephone,d OTE <br /> S <br /> SITE INFORMATION /,tlo ,0 <br /> ffl 1 arcelOwna� <br /> Sgm���- ¢� <br /> '7! <br /> Site Address <br /> CGS Cd"L� (- & —27 DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE X <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County High, <br /> Right-of-Way on the Wes, side of <br /> City,State-Zip Code approximately feet/mile 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 AppTormlDrivewayPaved frontage <br />