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t1_Z10Jas3 <br />COUNTY OF, SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: U 1 <br />Address: <br />City, State, Zip Code: <br />Area Code - Tele hone Number: G <br />Email: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address:(? <br />City, State, Zip Cade: <br />Area Code - Tele hone Numb 0 - <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Date: 14111041 <br />Received By: <br />CR#: d<W46 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County ay Right -of -Way on the <br />Film" side of wEsi &W. approximately 2if0 ile OJM <br />of -Mrl%0 44N. 71I Snt a , by installing <br />commence on or about <br />sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YESNO Contractor's License <br />X%ENCROALHWNT9 W, F.T"!Eh lENGNMOHAENF PERM OPNEWAYtl (") <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />APN <br />EXP. DATE: <br />STREET: <br />AREA: <br />TYPE: <br />FORMS:6 <br />NOTES: <br />11005 ISSUE DATE: <br />tn-64o-42- FEE DUE: <br />DRIVEWAYS: <br />WEST L4 - <br />SToc i%PJ QUAD <br />DuJ AP O.aAF-!� <br />rv� j? -g, a f4lp <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RAN <br />RESIDENCE: <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County ay Right -of -Way on the <br />Film" side of wEsi &W. approximately 2if0 ile OJM <br />of -Mrl%0 44N. 71I Snt a , by installing <br />commence on or about <br />sheet may be submitted) <br />for approximately <br />Will this project be self -installed? YESNO Contractor's License <br />X%ENCROALHWNT9 W, F.T"!Eh lENGNMOHAENF PERM OPNEWAYtl (") <br />days. <br />Work will <br />