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COUNTY OF SAN❑JOAQUIN �( Da#e: (2- Z�2B <br /> DEPARTIY/LINT OF rULIC WORKS <br /> �..�' <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION <br /> Name: APPLICANT OFFICE USE ONLY <br /> Address: JOB#: 11005 ISSUE DATE: IZ_2 —Zcky <br /> Ci ,State,Zip Code: G APN 22C_y b-- (,j FEE DUE: <br /> Area Code Tele hone Number: p to--- EXP.-DATE: DRIVEWAYS: <br /> STREET: rf <br /> SITE INFORMATION: AREA: ,y��,t Q CeQUAD S F„ <br /> Parcel Owner's Name: TYPE: <br /> Site Address: FORMS: <br /> City,State,Zip Code: a, NOTES: <br /> Area Code -Telephone Number- <br /> DRIVEWAY <br /> CONTR TOR TYPE: QUANTITY UVIDTHS <br /> Name: AGRICULTURE: OFRONTAGEEd <br /> Address: — COMMERCIAL. <br /> City,State,Zip Code: INDUSTRIAL �WW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft, <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County, way Right-d-Wayon the <br /> W z S T— side of LAt UV\, approximately 112 2- <br /> of <br /> by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? X, YES NO Contractor's License <br /> YAFORMS R TEMPLATESIENCROACHMENT PERMIT DRIVEWAY.doc(MM) <br />