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COUNTY OF SAN JOAQUIN Date: J— 00. 2 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: ,,�C,,,v <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERNUT APPLICATION .(�,,�t 1�( CR#:�.L4 <br /> APPLICANT OFFICE USE ONLY <br /> Name: �. tt �� :z� <br /> Address: 77 �vc24 JOB#: 11005 _ ISSUE DATE: <br /> City,State,ZipCode: z t APN Q 1 -L4, .43 FEE DUE: <br /> Area Code -T Number . c�<� _ 3-3 -� EXP.DATE: DRIVEWAYS: <br /> STREET: , S <br /> SITE INFORMATION: AREA QUAD— <br /> Pamei Owner's Name: v� s TYPE: 1 Vie h3� tc <br /> Site Address: 5s`y �,�.� S FORMS: S5 Gtr t <br /> City,State,Zip Code: i�,cu �OY�4b z c t S a 5V NOTES: <br /> Area Code..-Telephone Number: 10-i <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL.: R1W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Ttp undersigned hereby appDes for permission to excavate,construct and/or otherwise encroach on County H' y ' ht-of Way on the <br /> . j side of Mr)!�P �a v�e+�ra.t 3 approximately �r c� le <br /> of (" by installing <br /> commence on or about for approximately days. Work Will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self4nstalled? YES NO Contractor's License <br /> IWVVGf)V.ORGGHARESICENTRALSERVICESXCLERICALftB-SV.WKWAMER;pS1E(JCROACFMEMP8WDRIVEWAY.DOC (100) page IOf2 <br />