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COUNTY OF SAN JOAQUIN Date:/Received by l /v- l G.�n�Z <br /> —I� <br /> DEPARTMENT OF PUBLIC WORKS CR# ,• _3 fi> <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> p Ta e APN H-1---I_L2— FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> f Ad ess, STREET S-DGGe� RC/ <br /> 1 l "S AREA �hPnnhi /�....�., QUAD _ <br /> City,State-Zi Cod,e, ,r} (�r l TYPE �� # <br /> FORMS fQ5 'l <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> P 1Owner's Name <br /> Site Address DRIVEWAY <br /> 11 l TYPE QUANTITY WIDTHS <br /> C', S to-Zip,,Cood <br /> r" 4 -�+ G� �� CGRICE TUR @FRONTAGE <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> —7 RESIDENCE ✓ 100 <br /> CONTRACTOR PAVED FRONTAGE <br /> I ENGTH: 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_ /VaY side of Sz7egal <br /> approximately SOD ®/mile W P�f of <br /> City,State-Zip Code by installing <br /> —1�-v�dou—' � ' <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 App\Form\DrivewayPaved frontage <br />