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COUNTY OF SAN JOAQUIN Date: �_ <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION <br /> APPLICANT <br /> Name: o C'FICE USEY <br /> Address: JOB# <br /> Ci ,State,Zi Code:,$ C � �� ISSUE DATE: <br /> Area Code -Tele hone Number. APN FEE DUE: <br /> 20 3 $ EXP.DATE: DRIVMAYS; <br /> SITE INFORMATION: STREET. <br /> Parcel Owner's Name: AREA 1" <br /> aRP� 7'T w <br /> Site Address: Z `7 $ TYPE: <br /> , State,Zi Code: �c �q S <br /> Area Code -Telephone Number: NOTES. <br /> CONTRACTOR DRIVEWAY <br /> Name: �C v TYPE: QUANTITY WIDTHS <br /> Address: AGRICULTURE:.3 110#6R AGE <br /> Ci ,State,ZZip Code: C©itiERCIAL: <br /> Area Code -,Telephone Number: INDUSTRIAL: <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: FL X 1Tt-i: Ft <br /> The u�ndersigned hereby applies for permission to excavate construct and/or th <br /> oerwise encroach on Cooty Hkjtmq FR"-%%y on the <br /> of Uside of P`�L approximately <br /> by installing <br /> commence on or about Wyk will <br /> approximately <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? AYES <br /> NO Contractor's License <br /> HSJPWGOV.ORWHARESACENTRALSERVICES%CLERICALIPUB-SV,WK'MASTER.PSIENCROACFMENTPE(tC TDMVEWAY.DOC (100) <br /> Page 1 of 2 <br />