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COUNTY OF SAN JOAQUIN Date: /d g1/3 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: �9/ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: /W& <br /> APPLICANT OFFICE USE ONLY <br /> Name: no '� <br /> Address: g 0- JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN f�� 3(00- — FEE DUE: <br /> Area Code -Telephone Number: _ -7b EXP.DATE: DRIVEWAYS: <br /> STREET: �b At.�• " <br /> SITE INFORMATION: AREA: ZIA146AI QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: Z FORMS: <br /> City,State,Zip Code: C 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 /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi2h Right-of-Wa on the <br /> side of �E.,P i9yE approximately L6 e ���� <br /> ofDAI.py by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICAUPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRNEWAY.000 {09113) Page 1 of 2 <br />