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r ' <br /> COUNTY OF SAN JOAQUIN Date: to 12- <br /> DEPARTMENT OF PULIC WORKS 1 ,,me�qq <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: 4Y <br /> PERMIT APPLICATION CR <br /> APPLI ANT <br /> OFFICE USE ONLY <br /> r <br /> #. 11005 <br /> Zip Code: �5�v Lr ' . ISSUE DATE: <br /> -Telephone Number: ��" ��l7 FEE DUE: <br /> EXP. DATE: DRIVEWAYS: <br /> SITE INFORMATION: w paj STREET:AREA: ,q�lQ�h4�l�g <br /> rs !!!7 kraAl QUAD <br /> ssName: �J'�'y TYPE: .�,,�/ <br /> ,Zi Code: FORMS: <br /> - <br /> Telephone Number: NOTES: <br /> DRIVEWAY <br /> CONTRACTOR <br /> TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> Zip Code: COMMERCIAL: <br /> -Telephone Number: INDUSTRIAL: @ R/W <br /> RESIDENCE. <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: <br /> Ft. <br /> ersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi ay Rig -of-Way oP the <br /> side of tA� /,U�9/ Die <br /> 5_4,rCeljrJ /�t/A►1/ �7'dc/ approximately /D"Ieby installing <br /> ;e on or about for approximately Work will <br /> days. <br /> -1(,.Separate sheet may be submitted) <br /> ject be self-installed? YES NO Contractor's License <br /> HARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10/09) Pa eIof2 <br /> 9 <br />