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COUNTY OF SAN JOAQUIN Date: �y l Z`� l <br /> e <br /> DEPARTMENT OF PUBLIC WORKS Received byIL <br /> CR# 25(4 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> �L(- M C JAP.V,1L JOB# 11005 ISSUE DATE ,/ / <br /> 7301 • s i-EC Name APNO?,I - 0 0 - E'S FEE DUE S�'/�'V <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> QUAD <br /> ( City State-Zip Code TYPE --1 u.) <br /> FORMS a � <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION Q �� <br /> �li-tS <br /> mqc+fAx <+I�lh1.BEnt,Y /yY�Cl t j / <br /> Parcel Owner's Name <br /> 153 W , E- (o(-L[W— <br /> n Site Address <br /> aL RN O , (A 1S Z ZL DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone CONS4ERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE �4--- <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroacb�on.County Highway <br /> Right-of-Way on the_ —side of <br /> City,State-Zip Code approximately /0 J tJ r=0 mile C—rz A of <br /> by installing i <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 /> kocessTer AppTormlDrivewayPaved frontage <br />