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+ COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> ti 0� /Received By: t�-- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:(-,qqZ-u Z <br /> APPLICANT OFFICE USE ONLY <br /> Name: ` <br /> Address: l JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Coded, ,� n' Z z APN n0.-2, W V 1 EE DUE: <br /> Area Code -Tele hone Number: a lV EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SIT -INFORMAT AREA: OUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: FORMS: ss fwvt-), <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Numbe( <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> ThMundersigned hereby appli s for permission to excavat construct and/or otherwise encroach on County Hi hway Right-of- ay on the <br /> V \,--side of approximately I L le <br /> of k)zj._l 3k x m gnf r) , 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? f-YES NO Contractor's License <br /> IkSJPWGOV.ORGISHARES%CENTRALSERVICEMCLERICALTUB-SV.WKNASTER.PSIENCROACHMENT PERMfT DRIVEWAY.DOC (10109) Page 1 of 2 <br />