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COUNTY OF SAN JOAQUIN Date: <br /> �— <br /> DEPARTMENT OF PUBLIC WORKS Received byCR# Do�� <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> J2.�� 7e-Chw1 ctll/,-5 JOB# 11005 ISSUE DATE <br /> Name APN CXll -� �L j FEE DUE <br /> a� G (/ EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> Sc�� 5 Z�C�C(G ZG�✓ ) M;�T u �> QUAD /7lCCity,State-Zip Code TYPE <br /> FORM / <br /> (Area Code)Telephone NOTE - <br /> SITE INFORMATION /CS <br /> PeOwner's Name <br /> W74 <br /> `C.�� <br /> Site Address DRIVEWAY <br /> LV CAI — TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Area Code)Telephone <br /> INDUSTRIAL @ RAV_ <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> 4KW IL✓ l r ffGt`Z lM�;�'cL 'y LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> The undersigned hereby a plies for permission to encroach on County Highway <br /> Address <br /> Right-of-Way on the id,of <br /> City,State-Zip Code approximately feet!mile of <br /> r 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 /> Access\Per AppTorm\DrivewayPaved frontage -- <br />