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COUNTY OF SAN jOAQUIN Late: ��� to <br /> DEPARTMENT MENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> ARPLICM4T OFFICE USE ONLY <br /> Name: L -fn <br /> £ r i <br /> Address: v : Baa#: _ 11-005 ISSUE DATE: <br /> Cis y,state,Zip Code o) t i ARIV 1'3k-dao-t{ EEE DUE: <br /> Area Code -Telephone Number AXP.DATE: DRIVEWAYS: <br /> STREET: I - s ! <br /> SITE INFORMATION: l � AREA: 2�G�9 QUAD -`— <br /> �Pa�rrcelOwners Name: f 1.�1�. --i i vpE. <br /> dress: c{�� s /3r3vr lc _I ! FORMS: -- <br /> Cfiy.State,Zip Code: 57'b 44L- if-i3 NOTES: <br /> Area Code -Telephone Number: 0 - G,o7 — <br /> DRIVEWAY i <br /> ! CONTRACTOR ! STYPE QUANTITY WIDTHS <br /> i Dame: ; AGRICULTURE: i JeL FPONTAGE <br /> Address: i COMMERCIAL: , _ <br /> City,state.Zip code: INDUSTRIAL- ---— -— , <br /> I Area Code -Telephone Number. �—SIDEI�Ci=: <br /> - <br /> ) RE , <br /> 1 <br /> L PAVED FRONTAGE i <br /> L LENGTH: Ft X WIDTH: <br /> Th undersigned hereby applies'or permission to excavate,construct and/or otherwise encrq4 on County Highwy ight-ofAA ay on the <br /> side of approximately f e.- <br /> of by installing -__----_.—.._- <br /> -- _ Vy'oric wrill <br /> commence on or about for approximately— days.— <br /> SKETCH(Separate sheet may be submitted) -- <br /> � I <br /> I <br /> i <br /> i <br /> i <br /> i <br /> Ii <br /> l <br /> t <br /> 1 <br /> ! <br /> i <br /> i I <br /> i <br /> i <br /> i <br /> Will this project be seif-instailed? YES IVO Contractor's License <br /> M!.CEh'TPA S'ccR'd:CE LE`P..ICAlvoli&SV.A'KVaWSTER.PSt-NORCACHI&NT PEP.M7 DPSJeNV--Y:DO ,I x9) Page'ci 2 <br />