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COUNTY OF SAN JOAQUIN Date; —1�6 r /3 <br /> DEPARTMENT OF PULIC WORKS <br /> Received 8y: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> fie f( 7 PERMIT APPLICATION CR#: 4(Act 22g <br /> _APPLICANT OFFICE USE ONLY -- <br /> Name: ,tJ C KOC <br /> Address: A-e o JOB#: 11005 ISSUE DATE: <br /> Cit ,State,Zi Cade: oa 31 o APN <br /> Area Code -Tele hone Numbe►: 2.0 ��431 U- FEE DUE: <br /> -! ,�S EXP.DATE: _ DRIVEWAYS: <br /> Y g� <br /> SITE INFORMATION: STREET. <br /> _ AREA: t1 QUAD S E <br /> Parce!Owner's Name: Ct TYPE: <br /> Site Address: S 1 , •—,�. FORMS; <br /> k Cily,Slate,Zi Coder <br /> 4zJ NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> -.CONTRACTOR---._.—....--_ _ Tl'pE:------- -----QUANTITY <br /> Name: _ �_.-...__.._.. _ --WIDTHS- - <br /> Address: AGRICULTURE; @FRONTAGE <br /> _____ _ __ _ COMMERCIAL: <br /> Ci[ ,State,Zip Code: INDUSTRIAL: <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 ancro ch on County Highwa Ri hf of-Way on ttie <br /> _/�1olr}�. side of NICi•� f��S' c�c __approximately fe tm S� _ <br /> of .� Atl �, ,by installing <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 col3tractor's License <br /> t — <br /> (k'C(!t RALSt!KVICESCLI-RICALWU65V.VAW.U.$TERPSI 10noACIPI.ETif rami I11((YE thuoc (u?n3) P4010 <br />