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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By. <br /> —�-- <br /> PERMITAPPLICATION A. <br /> APPLICANT •�"` <br /> Name: - a-:1; OFFICE USE ONLY <br /> Address: . s_ �, <br /> Ci , State,Zip Code: - „ �,. JOB#: 11105 ISSUE DATE: <br /> Area Code -Tele hone Number: ,., 3iy APN - �. 24 FEE DUE: <br /> 3 EXP.DATE: RiVEWAYS: <br /> SITE INFORMATION: STREET: r <br /> Parcel Owner's Name: f, n ;,r '�� QUAD <br /> ,a�t TYPE: <br /> Site Address: ?, a�a 5� u v �_'e — .1+1 <br /> City,State,Zi Code: ,2 FORMS: -- <br /> f NOTES: <br /> Area Code -Tele hone Number: - �� � , -�, <br /> CONTRACTOR DRIVEWAY <br /> Name: y ; TYPE: QUANTII OFTY WIDTHS <br /> Address: F r ` ' �� AGRICULTURE: RrdTAGE <br /> Ci ,State,Zi Code. COMMERCIAL: <br /> Area Code -Tele hone Number: INDUSTRIAL: RAN <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 on County Highway side of y Right-of Wa on the <br /> of — approximately feet/mile y <br /> by installing <br /> commence on or about Work will <br /> for approximately <br /> days. <br /> 7(Separatee sheet may be submitted) <br /> i <br /> H <br /> 7 <br /> lei U r%✓'�`,, /= �� <br /> i <br /> Will this project be self-installed? `'YES <br /> NO Contractor's License <br /> VISJPWGOV.ORWHARESICENTRALSERVICESICLERICALIPU&SV.WKWASTER.PSIENCROACHMENTPERMTTDRN'EWAY.DOC (Ing) Page 1of2 <br />