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COUNTY OF SAN JOAQUIN Date: ,°y t� /o <br /> DEPARTMENT OF PULIC WORDS ; <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: _Lt/s+.4 <br /> PERMIT APPLICATIi3N <br /> APPLICANT <br /> Name: � 7FF-IC-E USE ONLY <br /> Address: i 7 74 ,��gr� ��. 7AREA <br /> Ci ,State,Zi Code: _ ISSUE DATE: <br /> Lam" � FEE DUE: <br /> Area Code -Tele hone Number: <br /> DRIVEWAYS: <br /> SITE INFORMATION:Parcel Owner's Name: QUAD <br /> Site Address: " w <br /> Ci ,State,Zi Code: G-T ;G3 Z NOTES: <br /> Area Code -Telephone Number: <br /> CONTRACTOR DRIVEWAY <br /> Name: TYPE: QUANTITY WIDTHS <br /> Address: AGRICULTURE: RONTAGE <br /> Ci ,State,Zi Code: COMMERCIAL: <br /> Area Code -Telephone Number: INDUSTRtAL: R/W <br /> RESIDENCE: p� <br /> 341 <br /> PAVED FRONTAGE <br /> CA ?5 Z53 LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encro <br /> of -�side of j �:-tom may, � County Highvwa ftht�on te <br /> , r- 1� approximately <br /> by installing <br /> commence on or about Work will <br /> for approximately <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES <br /> NO Contractors License <br /> k1SJPWGOV.ORG\SHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRNEWAY.DOC (1a%) <br /> Page t of 2 <br />