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COUNTY OF SAN JOAQUIN Date: /'C <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# O <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> ,, Name APN /? -/00 FEE DUE . <br /> iv • �� �� EXP.DATE DRIVEWAYS <br /> A ess � STREET <br /> -3S r'�Gi 6; 9 ,¢,�.1 //IL-c, ��r�A ) QUAD_ <br /> City,State-Zip Code TYPE �✓ <br /> C�fD r� vz �� `�IPZ07 FORMS fg d-UEI�� <br /> ry (Area Code)Telephone OTE <br /> r r�— Z / Z_ <br /> SITE INFORMATION yPS /Z j"��i <br /> Parcel Owner's Name <br /> Site Addr <br /> ei��1—rte DRIVEWAY <br /> c City,State-ZipCode , TYPE QUANTITY WIDTHS <br /> �7Sr moi' AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <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 jVA`14 side of <br /> City,State-Zip Code approximately D, QU feet W -S-)- 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 /> Hill this project be self-installed? NO YES Contractor's License <br /> 1ccess\Per AgpTorm\DrivewayPaved f-onge <br />