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COUNTY OF SAN JOAQUIN Date: 11 v <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: AAq� <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> Chy,State,Zip Code: 12, APN /x,57 FEE DUE: <br /> Area Code -Telephone Number: Zap - l EXP.-DATE: DRIVEWAYS: <br /> STREET: 6L_ 0 '04W. <br /> SITE INFORMATION: AREA: e1!°YA! QUAD <br /> Parcel Owner's Name; ,e> TYPE: <br /> Site Address: FORMS: „ ,�ts� 17 <br /> — <br /> Ci ,State,Zi Code: NOTES; <br /> Area Code -Telephone Number: / A/0 11, <br /> DRIVEWAY <br /> CONTf3ACTOR TYPE: QUANTITY WIDTHS <br /> Name: u, AGRICULTURE: OFRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: RIW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: R. X WIDTH: Ft <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Courviy HiMpy! t4-Way on the <br /> ;!SZs� side of . _�ytz, c� ,�irf. approximately <br /> of a I�Yr � ,by installing :T?6J <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-thstatled? YES NO Contractor's License <br /> Y:V01M i TEMP ATESi OIDACHMENT POW MeftYAoe <br />