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COUNTY OF SAN JOAQUIN Date:03 /u7 / Zo-e <br /> DEPARTMENT OF PUBLIC WORKS Received by A/ <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> _ \ E C JOB# 11005 ISSUE DATE <br /> Name APN ZO-7 - c o 03 FEE DUE <br /> �� (v `A e_r,( \C_A EXP.DATE DRIVEWAYS: <br /> Address_. J STREET cZ <br /> / City)State-Zip Code TYPE " <br /> `� FORMS <br /> (Area Code)Telephone NOTE <br /> / ( SITE INFORMATION- /`5 00 0-e <br /> Parcel Owners Name _ <br /> Site Address DRIVEWAY <br /> \ C State-'Zip Code TYPE QUANTITY WIDTHS <br /> 3 y _ AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE �— <br /> CONTRACTOR PAVEDFRONTAGE <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 Vne 44rof <br /> City,State-Zip Code approximately feet/mile of <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 /> Will this project be self-installed? _NO YES Contractor's License <br /> AccessTer App',Forrn�DrivewayPaved frontage <br />