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COUNTY OF SAN JOAQUIN Date: 21-Q5 41 <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRQNTA 2q�, Received By. <br /> PERMIT APPLICATION <br /> APPLICANT oFFlcE USE ONLY <br /> Name: !� j�,�,�, .�,` <br /> Address: 3 �� �� �. . C JOB#: 1 <br /> 1005 <br /> Ci ,State,Zi Code: 5� C A APN ISSUE DATE: <br /> FEE DUE: <br /> Area Code -Tele hone Number: EXP.DATE: � � -' pYS_ <br /> � <br /> SITE INFORSTREET: <br /> MATION: AREA: <br /> Parcel Owner's Name: QUAD " <br /> IL <br /> TYPE: <br /> Site Address:. ^� FORMS: <br /> Ci ,State, Code: j,f, C,� W I <br /> Area Code Telephone Number: ems: _ - r NOTES: <br /> ;� <br /> CONTRACTOR DRIVEWAYTYPE: QUANTITY <br /> Name: j , . C AGRICULTURE: WIDTHS <br /> Address: dTAGE <br /> L <br /> COMMERCIAL: <br /> R{ <br /> Cit ,State, Code: S cN �f, <br /> Area Code Telephone Number: INDUSTRIAL: <br /> } RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft <br /> The undersigned hereby applies for permissio�exca�vale, nstructand/or otherwise encroach on coanty rrra =t,_ on the <br /> of approximately l <br /> by installing <br /> commence on or about for approximately days.. Work will <br /> SKETCH'(Sep <br /> aratee sheet may be submitted) <br /> Will this project be self-installed? ! YES NO Contractor's License <br /> IISJPWGOV.ORGOWESICENTRALSERVICESICLERICALIPUR-SV.WKWWTER.PSIENCROACHMENTPERMITORIVEWAY.DOC pat <br /> Page t of 2 <br />