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COUNTY OF SAN JOAQUIN U <br /> • � ' Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By. <br /> PERMIT APPLICATION CR#:C—K <br /> APPLICANT OFFICE USE ONLY <br /> 2" JOB#: 11005 ISSUE DATE: <br /> Zip Code: e APN <br /> - <br /> Telephone Number FEE DUE: <br /> EXP. DATE: DRIVEWAYS: <br /> STREET: S� `J e� C fi <br /> SIT ORM TION: ,^ AREA: �, QUAD 12 <br /> ner's Name: q TYPE: <br /> ss: FORMS: <br /> Zi Code` 2 zZ NOTES: <br /> -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY <br /> �s 'e AGRICULTURE: WIDTHS <br /> z COMMERCIAL: FRONTAGE <br /> Zip Code: e �,� INDUSTRIAL: <br /> -Telephone Number: _ ,�3 RESIDENCE: @ R/W <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> ersigned hereby applies for emission to excava co ct and/or otherwise encroach on County Hi way ' ht-of-Way on the <br /> side of G approximately �n <br /> _ smile <br /> by installing <br /> ce on or about for approximately days. Work will <br /> H(Separate sheet may be submitted) <br /> eject be self-installed? YES NO Contractor's License <br /> ISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Pae 1 of2 <br /> 9 <br />