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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS - <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name: D ftIQ –b V(ZS <br /> Address: j O ( C JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: U 2-0 APN FEE DUE: <br /> Area Code -Tele hone Number: &21—66 EXP. DATE: DRIVEWAYS: <br /> STREET: 2, <br /> SITE INFORMATION: AREA: ,� QUAD <br /> Parcel Owner's Name: r' TYPE: <br /> Site Address: C, FORMS: <br /> Ci ,State,Zip Code: U NOTES: <br /> Area Code -Telephone Number: —gyp —Ip <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: ,ry <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applie for permission to excavate,construct and/or otherwise encroach on County Hi way Right-of-Way on the <br /> side of �GAW14l 49 approximately fee mile � r <br /> ofby installing a <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERMCEMCLERICALIPU&SV.WKWIASTER.PSIENCROACHMENT PERMIT DRNEWAY.DOC (10/09) Page 1 of 2 <br />