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4S - -LSD IS 10 COUNTY OF SAN JOAQUIN Date; <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: �cGL_ A4c1.4—C �1 <br />Address: <br />Cit , State, Zip Code; `_ <br />Area Code -Telephone Number: S—(� <br />Email: <br />SITE INFORMATION: <br />Parcel Owner's Name: Z�7 <br />Site Address: ZS'7 Z-5— <br />City, <br />'Cit , State, Zip Code: <br />Area Code -Telephone Number:G 76 Z/1 <br />CONTRACTOR <br />Namo, 4L ilfirY��}t c <br />Address; <br />Ci , State, Zip Codey <br />Area Code -Telephone Number: 47l� C. 71 G l., Z,A� <br />Received By: 1429 - <br />CR#: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of by installing <br />commence on or aboutWork will <br />for approximately days. <br />XU1CROACHME11TSUFa_Ix Fw Ttw&Ln 4CROAGHFEIH' FERMITDPjvmwe (oms) <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 7- <br />2 S 0. tom_ 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 WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RMI <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ff. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of by installing <br />commence on or aboutWork will <br />for approximately days. <br />XU1CROACHME11TSUFa_Ix Fw Ttw&Ln 4CROAGHFEIH' FERMITDPjvmwe (oms) <br />