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COUNTY OF SAN JOAQUIN Date: ? l 25 / Zoe <br /> DEPARTMENT OF PUBLIC WORKS Received by�.t ' <br /> CR# � <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNM APPLICATION <br /> / 7 APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN :U -C- FEE DUE <br /> eag4 /4,,Z Zt �L EXP.DATE DRIVEWAYS: <br /> Address STREETS&aber Offlwe <br /> AREAs Grp c% QUA _ <br /> City,State-Zip Code TYPE ` <br /> 1,,G s� -n - ;)Z� FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> —) ( A <br /> Site Address DRIVEWAY <br /> 7 J 2a TYPE QUANTITY WIDTHS <br /> City State-Zip Code AGRICULTURE @ FRONTAGE <br /> V?2 — JZ o,:--> COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> RESIDENCE ✓ <br /> CONTRACTOR PAVEDFRONTAGE <br /> y LENGTH: Ft. X WIDTH: Ft. <br /> t Nam <br /> t The undersigned hereby applies for ppTmission to encroach on Coun Highway <br /> Addres <br /> e/ Right-of-Way on e �T side of �[CrGin e i lye h u e <br /> amity,State-Zip Code approximately O /�e vo r 7-w of�� <br /> / KP 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 /> I � <br /> 0o2,4CH- <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aoo=\Per App�Form\DrivewayPaved frontage <br />