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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: � 8 2l <br />Received By: !x - <br />APPLICANT <br />Name: <br />11005 ISSUE DATE: <br />APN <br />Address: /9i <br />r v <br />Cit , State, Zi Code: <br />oAs. <br />1 <br />Area Code -Telephone <br />Number: <br />SITE INFORMATION: <br />Parcel Owner's Name <br />FORMS: <br />Site Address: <br />NOTES: <br />City, State, Zip Code: <br />DRIVEWAY <br />Area Code - Telephone <br />Number: <br />CONTRACTOR <br />Name: ck <br />AGRICULTURE: <br />Address:i" <br />t2wz4 � <br />City, State, Zi Code: <br />c?4g S <br />Area Code - Tele hone <br />Number: w7eir, fr9f$ 1 <br />Date: � 8 2l <br />Received By: !x - <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on Counly Hi hway Ri$ht-of-Wa-y on the <br />side of jrgv L�STl� i9VS approximately ee mile M <br />of 41A04ew d3r , by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />Con" <br />for approximately <br />Will this project be self -installed? ES NO <br />P.�ENCROgCHMEM51Maslafams Tarylelee�ENC0.0ACNMEIRPE0.ABi NPNEVIAYJoo�O&➢8) <br />Contractor's <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: /Yjq& <br />AREA: <br />QUAD 46 <br />TYPE: <br />oaf <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL: <br />@ RNV <br />RESIDENCE: <br />N <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on Counly Hi hway Ri$ht-of-Wa-y on the <br />side of jrgv L�STl� i9VS approximately ee mile M <br />of 41A04ew d3r , by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />Con" <br />for approximately <br />Will this project be self -installed? ES NO <br />P.�ENCROgCHMEM51Maslafams Tarylelee�ENC0.0ACNMEIRPE0.ABi NPNEVIAYJoo�O&➢8) <br />Contractor's <br />days. <br />Work will <br />