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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> -lc \ Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: D�a3 SS <br /> APPLICANT OFFICE USE ONLY <br /> Name: T7AT 0 ' <br /> Address: I o S-lKict v JOB#: 11005 ISSUE DATE: <br /> City,State,Zi Code: S l ri �b� ! APN d t5 0 c.� ct FEE DUE: <br /> Area Code -T hone Number. — EXP.DATE: DRIVEWAYS: <br /> STREET: ;AV V,,V �a_ <br /> SITE INFORMATION: AREA: L k i QUAD <br /> Parcel Owner's Name: '? 0 ' JU &1u__t_.. TYPE: , 1- <br /> Site Address: 1"0`tZ L I2 FORMS: �; E <br /> City,State,Zip Code: W i>t I C R 52-4 NOTES: <br /> Area Code -Telephone Number: Y c <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: FRONTAGE <br /> Address: 0 l COMMERCIAL: <br /> City,State, Code: fl- fNDUSTRIAL: R/W <br /> Area Code -Tel e N RESIDENCE: <br /> '4 c PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permissi n to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> N 6y, A_ side of T wy approximately feet/mile.` j� <br /> of Drny�4; ,by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self installed? YES NO Contractor's License <br /> OSJPWGDV.ORGGWESICEMRALSERVICEMLERICALVU&SV.WKNAASTER.PSeMOACHMENT PERMIT DRNEWAY.DOC (10109) Page 1 of 2 <br />