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COUN Y OF SAN JOAQUlN Date: <br /> DEPARTMENT OF PULIC(WORKS <br /> �-°- <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> - <br /> PERMIT APPLICATION CRS d4lSr'9 <br /> APPLICANT i ^y-FiC9 USE ONLY ; <br /> I Name: i�---- <br /> i Address:VO �30� '1 Co — i jOS# _ 1 DOCS ISSUE DATE: i <br /> City,State,Zip Code: i3 u it-�n r'} A i i APN ¢ j_�20 FEE DUE: <br /> Area Code -Telephone Number: a69 P.DATE: DRIVEWAYS: _ + <br /> ? i + STREET: ' <br /> I SITE INFORMATION: SG-4Grx1 QUAD <br /> iParcel OYvner's Name-.Ta K v-, F !'i;- � TYPE: <br /> i <br /> SiteAddress: 2Z S. U o FORMS: <br /> j I <br /> City.State.Zip Ci NOTES: — <br /> I <br /> ; Area Code -Telephone Number- <br /> DRIVEWAY <br /> I CONTRACTOR I TYPE: i DUAN,T I TY ! - VVIDTHS <br /> i <br /> i Name: i AGRICULTURE: ' @FPON T AGE 1 <br /> Address: _ i COMMERCIAL: i —�` <br /> i Zip Code: __ ( i INDUSTRIAL: "p" <br /> -- <br /> iArea Code -Telephone Number: ----- `f �RESIDENCE: <br /> � --- - <br /> I <br /> PAVED FRONTAGE j <br /> I LENGTH: Ft X WIDTH: Ft, <br /> he,nder igned hereby appii`s f perm construct and/or othemfise en ch on County Highway•ay Righ f-W— the <br /> side approximately ) <br /> Of— _ by installing <br /> —_ trdork VAN <br /> commence on dr about for approximately — days. <br /> SKETCH(Separate sheet may be submitted) i <br /> i <br /> ' s <br /> s <br /> r ? <br /> i <br /> I <br /> i <br /> Ii <br /> i <br /> i <br /> e ! <br /> I <br /> i <br /> `)Mill this project be self-installed? YES Ivo Contractors License <br /> �'.tCE.i'PA!SERV:CES'G:Er',ICfiLoi;3-SV.A K\0.�uTER.7Sl�FiC>ingCnME!2T P�RFiq'f DP.IVE'.I.4Y.u0C (?w. , Page 1 ci 2 <br />