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21v 3043 <br />COUNTY OF SAN JOAQUIN Date: <br />DEPARTMENT OF PULIC WORKS <br />Received By: <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION CR#: O73r� <br />APPLICANT <br />Name:l <br />l tUN fzocez� <br />Address V S • C !a * G <br />Cityr,State, Zip Code:,2 o c o <br />Area Code - Tele hone Number: /o ye-, G <br />Email: u 1 n ) n✓ a s <br />EXP. DATE: <br />SITE INFORMATION: <br />Parcel <br />Owner's Name: <br />Site Address: 2�l l 8 l <br />AREA: <br />City, State, Zip Code: C v q o <br />Area Code -Telephone Number: <br />CONTRACTOR <br />Name: t'6 e 4r <br />Address: <br />City, <br />State, <br />Zip Code: <br />Area Code <br />-Telephone <br />DRIVEWAY <br />Number: <br />The undersigned hereby applie$§ for permission to excavate, construct andlor otherwise encroach on County Hi ay Ri t -of -Way on the <br />EA•1r side of approximately ile <br />Of F74WA*M Tr by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YES NO Contractor's License <br />X1ENCft0ApiMEMSIMuIer FamsTertpblalENCRMCNAEMPENMTURNEWAY doc�OAM) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN Z S ( FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD :!!%tJ <br />TYPE:/ <br />AO �iY <br />FORMS: w <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ <br />RIW <br />RESIDENCE: <br />X <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applie$§ for permission to excavate, construct andlor otherwise encroach on County Hi ay Ri t -of -Way on the <br />EA•1r side of approximately ile <br />Of F74WA*M Tr by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YES NO Contractor's License <br />X1ENCft0ApiMEMSIMuIer FamsTertpblalENCRMCNAEMPENMTURNEWAY doc�OAM) <br />days. <br />Work will <br />