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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: <br />JOB #: <br />11005 ISSUE DATE: <br />APIN <br />Address: t � � <br />EXP, DATE: <br />DRIVEWAYS: <br />City, State, Zp Code: <br />AREA: <br />Area Code - Tele hone Number: - --f <br />TYPE: <br />Email: re <br />FORMS: <br />eG s <br />NOTES: <br />SITE INFORMATION: <br />Parcel Owner's Name: S <br />TYPE: <br />QUANTITY <br />Site Address: Z S6.0 <br />AGRICULTURE: <br />Cit , State, Zip Code: Eke <br />Area Code -Telephone <br />Number: �IS— <br />@FRONTAGE <br />COMMERCIAL: <br />CONTRACTOR <br />Name: 5hle <br />'D <br />Address: <br />City, State, Zip Code: <br />q <br />Zzc-s <br />Area Code -Telephone Number: 'y — <br />-1 <br />Ft. X WIDTH: Ft. <br />b <br />Date: <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeurnile <br />Of , by installing <br />* u u. *^,7"T'T.1if��7iL7�12drli <br />sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? YES X NO Contractor's License � � f �0 �U <br />k�ENg20AGINfNiSlMaster FwmsTertpbla�ENCRWCHF£MPERMT �RNEWAYtloo�O&V8) <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APIN <br />FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <br />FORMS: <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: Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeurnile <br />Of , by installing <br />* u u. *^,7"T'T.1if��7iL7�12drli <br />sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? YES X NO Contractor's License � � f �0 �U <br />k�ENg20AGINfNiSlMaster FwmsTertpbla�ENCRWCHF£MPERMT �RNEWAYtloo�O&V8) <br />