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COUNTY OF SAN JOAQUIN Date: " / %7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APP CANT OFFICE USE ONLY <br /> 6 K JOB# 11005 ISSUE DATE <br /> Name APN 2Dj- ;� - _J� FEE DUE 4;LO <br /> EXP.DATE DRIVEWAYS: <br /> Address f STREET LE"� <br /> o . <br /> QUAD f,2-- <br /> City, <br /> ,2=City,State-Zip Code TYPE i/J <br /> q 4 i D/ '- FORMS --5 x Z22 <br /> (Area Code)Telephone OTE <br /> SITE INF ION <br /> ..� arcql Ownel,Names <br /> Site Address DRIVEWAY <br /> e6> / TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL — @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby ap es for ernission to encroach on Count ghway <br /> Right-of-Way on the� side of U 8h 6/ p/ <br /> City,State-Zip Code approximately I feet/ fe /�! f of All <br /> by instaltiug <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 /> Access\per AppTormorivewayPave3 frontage <br />