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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: 01"a <br />Received By: <br />APPLICANT <br />J013 #: <br />Name: - <br />t4 14A 0� <br />Address: q <br />FEE DUE: <br />City, State, Zip Code: 5- <br />Area Code *Telephone Number: — q <br />Email: <br />C <br />/t2 i -1 <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />( k <br />City, Stale, Zip Code: <br />Area Code "Telephone <br />Number: <br />CONTRACTOR <br />Name: <br />TYPE: <br />Address: <br />WIDTHS <br />City, State, Zip Code: <br />Area Code <br />- <br />Telephone <br />FRONTAGE <br />Number: <br />Date: 01"a <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Righi-of-Way on the <br />� COK. side of . approximately 10X4 feeUmile <br />of by installing C v -h. gyp' r. i a A -r C u k6 <br />Work will <br />commence on or about sr d- for approximately � days. <br />SKETCH (Separate sheet maybe submitted) <br />A Crk<, <br />Will this pro <br />ject beself-Installed? _YES NO Contractor's License <br />%'xltcFadin![xrsxlouui..ma.iw,,W...erzxaan�ueinnawi puvnvar.ax. �,dWl <br />OFFICE USE ONLY <br />J013 #: <br />11006 ISSUE DATE: <br />APN <br />FEE DUE: <br />EXP. DATE: <br />_ _ DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RM <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft, <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Righi-of-Way on the <br />� COK. side of . approximately 10X4 feeUmile <br />of by installing C v -h. gyp' r. i a A -r C u k6 <br />Work will <br />commence on or about sr d- for approximately � days. <br />SKETCH (Separate sheet maybe submitted) <br />A Crk<, <br />Will this pro <br />ject beself-Installed? _YES NO Contractor's License <br />%'xltcFadin![xrsxlouui..ma.iw,,W...erzxaan�ueinnawi puvnvar.ax. �,dWl <br />