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COUNTY OF SAN JOAQUIN Dater <br /> Received <br /> DEPARTMENT OF PUBLIC WORKS CR# O 7> <br /> DFaIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> S IC OFFICE USE ONLY <br /> AP <br /> �' JOB# 11005 ISSUE DATE I � <br /> Neje' APN Jaa--0 -_1 FEE DUE <br /> 1�'C Cd I AVL- EXP.DATE DRIVEWAYS: <br /> Add'yress STREET f C7/- 73 <br /> QUAD Sr <br /> City,State-Zip Code TYPE <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> SITE RI RgRMATIONNQ <br /> C V'�v i I CA,' "J() <br /> Parcel Owners Names <br /> rte Adc ess DRIVEWAY <br /> C7 VA (( l F7')Z-() TYPE QUANTITY WIDTHS <br /> City State-Zip(. AGRICULTURE <br /> Code @ FRONTAGE. -� � <br /> COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W— <br /> RESIDENCE <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 side of <br /> approximately ) G- feet/v iMe := of tia� -a <br /> City,State-Zip Code ,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 ApplFormDrivewayPaved frontage _. <br />