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COUNTY OF SAN JOAQUIN Dater/ 2w-1 <br /> DEPARTMENT OF PUBLIC WORKS Received by �� <br /> CR# <br /> DRIVEWAY ANIS PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APP,L.ICANT OFFICE USE ONLY <br /> �1 JOB# 11005 ISSUE DATE <br /> Name APN OC-045 -,a_ FEE DUE <br /> 34"i t') bkoh--I EXP.DATE DRIVEWAYS: <br /> Address ` STREET�r-L jnPY 12d <br /> AREA Gr QUAD A) � <br /> 1 City,State-Z. Code TYPE <br /> ✓,cam C k - 2-J Z FORMS <br /> (Area Code)Telephone NOTE <br /> 2u`7 -- -3,32a22_(,,,0 <br /> SITE INFORMATION 12 tr <br /> Parcel Owner's Name <br /> Site dress <br /> 2�7�3 NA �t f- DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> ` CA <br /> C.)y.L{Z AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> 2(f--1 �D_ 7l-7:5RESIDENCE <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 Ali( -Y/-A side of <br /> City,State-Zip Code approximately_feet/Cn1e_2 IA/?<°k of ),>Vi Ier c <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 /> Hill this project be self-installed? NO YES Contractor's License <br /> kaessTer App\Form\DrivewayPaved frontage <br />