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COUNTY OF SAN JOAQUIN Date:/f / i4,l o 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by P r <br /> CR# C2:33 3 7 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> �( JOB# 11005 ISSUE DATE / <br /> Name ` APN,,L-/Zh -� FEE DUE <br /> �Ct k-_ EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> AREA s6 ��tom., QUA A/,57 <br /> City State-Zip Code TYPE <br /> ( Zoe? ( q ��— FORMS <br /> (Area Code)Telephone NOTE �/ <br /> SITE INFORMATION /"o <br /> c— <br /> Parcel Owner's Name <br /> Site Address DRIVEWAY <br /> CiC�StaiiLatte--ZiTSE 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 applies for permission to encroach on County Highway <br /> Right-of-Way on the side of <br /> City,State-Zip Code approximately D v fe /mile 5'a of ",4" <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 AppTotmOrivewayPaved frontage <br />