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Date:�l 21 ! LOoSr <br /> COUNTY OF SAN JOAQUIN Received by nw � <br /> DEPARTMENT OF PUBLIC WORKS CR# O 3 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> APPLICANT JOB# 11005 ISSUE DATE ! ! <br /> ,�q FEE DUE <br /> l Name APN Cj21 - 6Y� '"—{ <br /> f i DRIVEWAYS: <br /> �,d�� �C!��� i-.� EXP.DATE <br /> -A dress STREET Q �� %e �d QUAD /I16 <br /> 711 <br /> City,State-Zip Code TYPE <br /> FORMS <br /> NOTE <br /> —r°—^-- (Area Code)Telephone <br /> loy9e s <br /> SITE INFORMATION <br /> parcel Owner's Name <br /> Site Address DRIVEWAY <br /> 1�r <- 1 i .—, — TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE C FRONTAGE <br /> (-- 1 J 1--,; � COMMERCIAL r_ - <br /> (Area Code)Telephone INDUSTRIAL R/VV <br /> RESIDENCE <br /> RONTAGE <br /> CONTRACTOR Ft. X WIDTH: Ft. <br /> ��� <br /> � — � / LENGTH: <br /> Name _ f <br /> L � /. l �` ' The undersigned hereby applies for permission to en roach on County High«'a}' <br /> �ddres� Right-of--Way on the side of ( rMe 6�— <br /> o L ? J feet/ 1 i(JOrfLi of <br /> �1`l�-.-� approximately _ C� — <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 protect be self-installed' NO <br /> YES Contractor's License <br /> AccessTer AppTorm`IhivewayPaved frontage <br />