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COUNTY OF SAN JOAQUIN Date: :Mal/y <br /> DEPARTMENT OF PULIC WORKS / i <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: 0111652 z <br /> Name: <br /> APP (CANT <br /> OFFICE USE ONLY <br /> Address: 0 Q JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: c S x qD APN <br /> Area Code -Tele hone Number: ����Zd-5 FEE DUE: <br /> cc 3� EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION- AREA: �p / QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: ( X FORMS: <br /> Cit ,State,Zi Code: �, <br /> S�'{ NOTES: <br /> Area Code -Telephone Number: � ,a0v, , — <br /> DRIVEWAY <br /> CONTRACTOR TYPE: ANTITY <br /> Name: AGRICULTURE: WIDTHS <br /> Address: (q)FRONTAGE <br /> City, State,Zip Code: COMMERCIAL: <br /> Area Code -Telephone Number: INDUSTRIAL: @ R/UV <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T�undersigned hereby applies or permission to excavate,construct and/or otherwise encroach on County way Right-of-Way on the <br /> side off/h/1�/ G,�/ approximately "70 fe <br /> of ,�,/�l l�OA,/fit ,�f� <br /> ` by installing <br /> commence on or about for approximatelydays. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES _NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIEPICROACHMENT PERMIT DRIVEWAY.DOC (10/09) Pae 1 of 2 <br /> 9 <br />