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_// 1 <br /> COUNTY OF SAN JOAQUIN Date: `� / +9/ 07 <br /> DEPARTIvENT OF PUBLIC WORKS Received byCR# 0---1 e-G 1 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DAT;j <br /> ff Name APN/-,�L- FEE DUE� <br /> b1, 9A EXP.DATE DRIVEWAYS: <br /> Ad ess STREETS ,rZlt <br /> A 577be-&-" QUAD <br /> r City,State-Zip Code TYPE ?Z� <br /> /----`7-0 X-) C-A1�E GD FORMS - <br /> (Area Code)Telepho e NOTE —T <br /> SITE INFORMATIONS <br /> t` <br /> P�rcelq/ tlJ Name <br /> Site Address <br /> ,v V3,V - �,3-rat u/r) /, TYPE <br /> QUANTITY WIDTHS <br /> City,State-Zip Code Ste_ <br /> AGRICULTURE @FRONTAGE <br /> r--A- <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 !�12:j�-/n side of i!l/l i�v <br /> City,State-Zip Code <br /> approximately 1`eet mile `' ac-4- of '' '�f= S'� <br /> ,bYn8 <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 AppTormTriveaayFaved frontage <br />