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zb0� <br /> COUNTY OF SAN JOAQUIN Dater? /-!I/ <br /> by 0/0 _— <br /> DEPARTMENT OF PUBLIC WORKS CR# 6.3 SA <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> �p y{ ���L• JOB# 11005 ISSUE DATE <br /> CJ �vn APNQ G3-0$V- FEE DUE <br /> t,,� �� Name EXP.DATE DRIVEWAYS: <br /> 1 vy �n y <br /> Address f, �,'D STREET A AREA QUAD <br /> City,State-Zip Code TYPE 1�U✓ <br /> U) <br /> FORMS Gv "��' 1 (1 �►����, <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION mak% <br /> R �Parcel Owner's Name( Siteidress 1 DRIVEWAY <br /> l 2-,3 l ce `5 Z"`f TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> z0 Q `3 O C2*1- COMMERCIAL --— <br /> (Area Code)Telephone INDUSTRIAL @° RIVV <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Highway <br /> Address Right-of-Way on the Q✓, side of <br /> approximately -0I fee e AXSte" of <br /> City,State-Zip Code p. 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 App\FormOrivewayPaved frontage <br />