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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APNO&`s-2-2L�-7�� FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET /i,—". 6'2 <br /> 1�>�� QUA — <br /> // State-Zip Code TYPEi�_ <br /> ell ^Zz/U FORMS <br /> (Area Code)Telephone OTE <br /> SITE INFORMATION <br /> � )9 , <br /> Parcel er's Name <br /> DOA) I�1 <br /> 1,;7,e/s <br /> Site Address DRIVEWAY <br /> / LSC`'£ �-°,4I< r� — TYPE QUANTITY WIDTHS <br /> Cly,State-Zip Code AGRICULTURE @ FRONTAGE <br /> ='h� .'�- � •�--Z-�''6 <br /> (Area Code)Telephone CoMrniExCIAI,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 h� <br /> City,State-Zip Code approximately Q,(k feet/ le) WPS� of rack eb <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 /> Vill this project be self-installed? _NO YES Contractor's License <br /> WcesslPer App\Form`DrivewayPaved frontage <br />