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COUNTY OF SAN JOAQUIN Date: IZ/ 3 /07 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> F r C C ; e r1 JOB# 11005 ISSUE DATE <br /> Name APN�- -40 0FEE DUE <br /> pc) 'JX),X { J EXP.DATE DRIVEWAYS: <br /> Address STREET Sf/ECTO % Wiz' <br /> L `A 5J� /iriJ�' ^ QUAD /VE' <br /> City, tate-Zip Code TYPE # <br /> C)Ct— <N - - FORMS Cly � <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION_ <br /> Parcel er's Name <br /> Site Address <br /> L� e- C A cr:5- -4 3 (' DRIVEWAY <br /> / City,State-Zip Code QUANTITY WIDTHS <br /> r)U9 � K z ^ 9 ou it AGRICULTURE ! — @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> U -sir+ <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encro9tch on County Highway <br /> Right-of-Way on the A JA,-M side of <br /> City,State-Zip Code approximately ]�feet/ _L&'5 A of <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 /> AccessTer AppTorm\DrivewayPaved frontage <br />