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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />�a��Pamagl�gmaii. conn <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE USE ONLY <br />Name: Gl <br />) h ; n - 4^ <br />APN I <br />Address: t L S <br />a 10( 4Ve <br />. <br />City, State, Zip Code:J r <br />A. q <br />S <br />Area Code - Tele hone N tuber: SI o Zoo - <br />64 R � <br />SITE INFORMATION: <br />FORMS: vilt <br />Parcel Owner's Name:a <br />h <br />i n L <br />o oomSite Address: '2 (1 c <br />City, State, Zip Code: S ocHoE , cw,q, <br />ystos' <br />Area Code - Telephone Number: Si o - W- 64qj <br />WIDTHS <br />CONTRACTOR <br />AGRICULTURE: <br />Name: Matt <br />eW 7r, V3cryv�a <br />FRONTAGE <br />Address: Sojo2bSf&r S <br />City, State, Zip Code: p rok, o. y, 9 <br />H 6 <br />Area Code -Telephone Number: 415 -69.3 <br />Date: i2- 13 - Zo21 ___ <br />Received By: _�wim <br />CR #: 0733&(49 <br />The nders)gnetl hereby appli�eSS for permission tAA--excavate, construct and/or otherwise en roach on County Hi ay Ri ht -of -Way on the <br />side of GG�i/f!y KW, approximately e e <br />of�W��j2o�l7' , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YES � NO Contractor's License � g � z � 1 <br />P:�ENCflogLNMEiRSNfazlx Fw,rsiaroMIn1ENLR0ALHlAEMPERMH flHNEWAY.tloc�OeNe) <br />days. <br />Vi�iT;i47111 <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN I <br />IUD.Q(o FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />AD SS <br />TYPE: <br />A40404ch <br />FORMS: vilt <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />X <br />INDUSTRIAL: <br />@ RAN <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The nders)gnetl hereby appli�eSS for permission tAA--excavate, construct and/or otherwise en roach on County Hi ay Ri ht -of -Way on the <br />side of GG�i/f!y KW, approximately e e <br />of�W��j2o�l7' , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YES � NO Contractor's License � g � z � 1 <br />P:�ENCflogLNMEiRSNfazlx Fw,rsiaroMIn1ENLR0ALHlAEMPERMH flHNEWAY.tloc�OeNe) <br />days. <br />Vi�iT;i47111 <br />