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COUNTY OF SAN JOAQUIN Dater/�/6 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0 '� f <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICA'T'ION <br /> APPLICANT OFFICE USE ONLY <br /> N �Fv 1p C— ' JOB# 11005 ISSUE DATE ! / <br /> Name APN 2 Z` _ -_ 4 FEE DUE ?E2Z,) <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> S C��f) C�! <br /> � �<J�' AREA QUADS <br /> ^City,State,-Zi� Code TYPE �`7w�LC �— FORMS <br /> T— (Area Code)Telephone NOTE <br /> SITE,INFORM TION « <br /> Parcel.,Qwner's Name <br /> _ S}' ddress _ -� <br /> S C+11_l�� l_.1`� 0� �� �1�. DRIVEWAY <br /> rty,State-Zip Code TYPE QUANTITY WIDTHS <br /> JAGRICULTURE @ FRONTAGE <br /> mea Code)Telephone CONUYfERCIAL <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 2�—&;,L. side of <br /> City,State-Zip Code approximately 4,a2eet mile of C(ic Z <br /> by installing <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitte(f <br /> Will this project be self-installed? NO YES Contractor's License <br /> AccessTer AppTorm`DrivewayPaved frontage <br />