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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMT APPLICATION "404 5,•• <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: S n JOB#: 11005 ISSUE[SATE: <br /> Ci ,State,Zi Coder ` APN _�����€E DUE: <br /> Area Code -Telephone Number: EXP.DATE: <br /> IVEWAYS: <br /> STREET: , <br /> SITE INFORMATION: AREA: <br /> Parcel Owner's Name: vy, TYPE: <br /> Site Address: > FORMS: <br /> Ci ,State,Zi Code: - NOTES: <br /> Area Code -Tele hone Number: <br /> CONTRACTOR DRIVEWAY <br /> Name: �.t.� _ TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: RONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zi Code: INDUSTRIAL: <br /> Area Code -Telephone Number: RNV <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X IM1►IDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on ft <br /> of side of approximately on on <br /> by installing <br /> commence on or about for approximatelyWork wnN <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? �ES NO Contractor's License <br /> k&PWGOV.ORGISHARESICENTRALSERVtCE&CLERrAL1PUg.SV.WKWASTER pS ENCRQq NT pBRW DRAY DOC (,per <br /> Page 1 of 2 <br />