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COUNTY OF SAN JOAQUIN Date: -` <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAY;;AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> JOB#: 11005 ISSUE DATE: <br /> e,Zip Code: j Cf' ir.�c C: s?l APN - <br /> flog {� FEE DUE: <br /> le. -Telephone Number: ( �?c-,) �_'<rx'- l,>� EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: -�a� ;b,t/ QUAD <br /> Nner's Name: TYPE: * -- <br /> ess FORMS: — <br /> Zip Code: , ti- -- . NOTES: <br /> - <br /> e -Telephone Number{ <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> COMMERCIAL: <br /> Zip Code: INDUSTRIAL: @ RMJ <br /> a -Telephone Number: RESIDENCE: aC <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> idersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Co�HihwlRight-of-Way on the <br /> side of ,1.,x,115,6C �&, approximately /,`,OGr ��=_by installing '7)IV <br /> Work will <br /> mce on or about for approximately days. <br /> "CH(Separate sheet may be submitted) - <br /> project be self-installed? YES _NO Contractor's License <br /> DRGISHARESICENTRALSERVICESICLERICALIPUD-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />