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COUNTY OF SAN jOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS —4�04-0 <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION <br /> APPUCANTOFFICE USE ONLY <br /> !_.Na <br /> Address: <br /> JOB 11005 ISSUE DATE: <br /> L City,State,Zip Code: <br /> APN FEE DUE: <br /> ILArea Code -Telephone Number: 1,f 7.;L-4-54.1 -T <br /> EXP.DATE: <br /> DRIVEWAYS. <br /> STREET: <br /> 4D <br /> SITE iNFORMATION.- I i AREA: . <br /> QUAD <br /> 'y <br /> Parcel Owner's Name. <br /> TYPE: <br /> r <br /> — <br /> F Site Address: <br /> 119Lt .neseFORMS:ORMS: <br /> i.-City,State,Zip Code: 'JS�04 ( MOTES: <br /> !�-,'%FeaCode -Tel ePhone Number. aclk-_i*,17-6etgl( <br /> I DRIVEWAY <br /> CONTRACTOR <br /> Name: PE: QUANTIT Y WIDTHS <br /> S i AGRICULTURE: —','-TFRONTAGE <br /> Address: T>6 <br /> to, COMMERCIAL. <br /> City,State,Zip Code: INDUSTRIA L: <br /> Area Code -Te!ephone Number: ------- <br /> - -------j <br /> RESIDENCE: T <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on eCounty H' a$y Right-of-Wa on the <br /> side of approximately /5 -e <br /> of--C445 ;40 , -0 Ile <br /> commence on or about —_--------- - -- _Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted'� <br /> Will this project be seif-installed? ',ES _NG Contractors License <br />