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COUNTY OF SAN JOAQUI'N Date: I2 Ip <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CIS# <br /> APPLICANT OFFICE USE ONLY <br /> Name: Y .J L f. <br /> Address: i / C Cr;L JOB#: 11005 ISSUE DATE: <br /> ^ Ci ,State,Zi Code: , ; ` : r >S APN <br /> 2-. <br /> Area Code -Tele hone Number. , -,.s FEE DUE: <br /> r .� �' EXP.DATE: DRIVEWAYS. <br /> STREET: , , , <br /> SITE INFORMATION: AREA: � �, QUAD , <br /> Parcel Owner's Name. TYPE: <br /> Site Address: "%Gf . i FORMS: -17 <br /> State,Zip Code: 3 ti , NOTES: <br /> Area Code -Telephone Number: _% <br /> DRIVEWAY <br /> Name: <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: <br /> Address: ONTAGE <br /> Ci ,State,Zi COMMERCIAL: <br /> Code: INDUSTRIAL: <br /> Area Code -Tele hone Number. <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH Ft <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach onCoun r H' <br /> d6g -H side of -Trak_`! c�L40jy Xz approximately_ RJW-ofWay on the <br /> of.. Xftk by instalf ng t u� <br /> commence on or about for approximatelydays. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> it/o 7�2i vE W>9j� A1116 1 �41W,eb6g� �/�OSS�BLf� Gi7?lE o f j$2445 <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORWHARESICENTRALSERWCESICLERICALIPU&SV.WKIMASTER.PMNCROACHMENTPERMITDRIVEWAY.DOC (10109) <br /> Page 1 of 2 <br />