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COUNTY OF SAN JOAQUINDate: <br /> DEPARTMENT OF PULIC WORKS S" <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: --1�—----- <br /> PERMIT APPLICATION CR#.—� ' <br /> APPLICANT <br /> Name: / ,�'c3 jrG OFF USE ONLY <br /> Address_�j��-- -t r. �. <br /> City,State,Zi Code: c.� JOB#: 11th ISSUE DATE: <br /> Area Code -Tele hone Number: �" S f APP _AZy <br /> EXP.DATE: FEE DUE: <br /> STREET: DRIVEWAYS <br /> SITE INFORMATION: YiFS , <br /> Parcel Owner's Name; ,a v7 AREA: ,C O p/ QUAD <br /> Site Address: i qj p _ TYPE- <br /> Ci ,State,Zi Code: U FORMS: <br /> 2-- NOTES- <br /> Al ud Code -Telephone Num be : s <br /> CONTRACTOR DRIVEWAY <br /> Name: TYPE: C lANTITY WIDTHS <br /> Address: AGRICULTURE: <br /> State,Zip Code COMMERCIAL: ACsE <br /> Area Code -Telephone Number INDUSTRIAL: RAN <br /> RESIDENCE: X/ <br /> PAVED FRONTAGE <br /> LENGTH: Ft X WiflTH: <br /> The undersigned hereby applies for permission to excavate,construct an othennrise encroach on Coun H' Ft <br /> _-X_side of Z�c lett-oINay on the <br /> H- <br /> of A,Q�lgS�►�O,yi �,- ,,1 S 'rZn. approximately 1�+ <br /> by installing <br /> commence on or about Work win <br /> for approximately <br /> SKETCH(Separate sheet may be submitted) <br /> WHI this project be self-installed? YES <br /> NO Contractor's License <br /> N GOV.ORGISFMEMENTRALSERViCESICLERICALIPUB-SV.WKIMASTER PS1ENCROACFUENT PERMIT DRIVEWAY.DOC (}apg) <br /> Page t az <br />