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COUNTY OF SAN JOAQUIN Date: //,��/Z, <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: 4�W7403a <br /> APPLICANT OFFICE USE ONLY <br /> E <br /> : —c � 0-,F <br /> ss: ,_ JOB#: 11005 ISSUE DATE: <br /> tate,Zip Code. ) C- -- APN ( _Q Q_ �] FEE DUE: <br /> ode -Tele hone Number: EXP. DATE: RIVEWAYS: <br /> STREET:SITE INFORMATION: AREA: QUAD <br /> Owner's Name: 1_ TYPE: Wdress: r FORMS: $ wW <br /> City, State,Zip Code: 10 ' -Z NOTES: <br /> Area Code -Telephone Number: - <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Thlip <br /> e undersigned hereby applies for permission to excavate,construct and/or otherwise encrgacho County Hi hway Right-of-Way on the <br /> side of !fes Y!! D. approximately 49 ee tiif�* 9AS <br /> of by installing D <br /> commence on or aboutfor Work will <br /> approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WNIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of <br />