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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT'OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 7 FEE DUE ISSUE DATR <br /> Name APN P6 -— Esc e <br /> $ EXP.DATE A14RIVEWAYS: <br /> Address STREET ^=), <br /> AREA VkA A QUAD <br /> City,State-Zip Code TYPE-;--Y4 <br /> FORMS X 1 <br /> (Area Code)Telephone NOTE <br /> Jz, <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Siddress DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COM]vIERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> L <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby SpOlies for permission to encroach on County Highway <br /> Right-of-Way on the ZLside of Ziz-,c <br /> approximately of 6te <br /> City,State-Zip Code 112- <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 /> Will this project be self-installed? —,NO YES Contractor's License <br /> Aocess\Per AppTormDrivewayl?aved frontage <br />