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"I <br />W <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Dafe <br />Receivedd By: / � <br />Q ,/ <br />APPLICANT <br />Name: <br />11005 ISSUE DATE: <br />APN <br />Address: <br />City, State, Zir Code: <br />4135 <br />Area Code -I elehone <br />Number 740 <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />57MAry✓ QUAD <br />Site Address: <br />jam ✓ c'>✓J <br />City, State, Zip Code: <br />JIB -/7 <br />Area Code -Telephone <br />Number: <br />DRIVEWAY <br />CONTRACTOR <br />Name: <br />Address: <br />WIDTHS <br />City, State, Zip Code: <br />Area Code - Telephone <br />Number: <br />Dafe <br />Receivedd By: / � <br />Q ,/ <br />The undersigned hereby applies for per fission to excavate, construct and/or otherwise envy ; Yh9n County Hi y Ri t -of -Way on the <br />6X side of ;4yo approximately IMM e�mile <br />of � 499 �� by installing <br />Work will <br />commence on or about for approximately days. <br />01) Separate sheet may be submitted) <br />Will this project be self -installed? AYES NO <br />P.�FHLRCALHMCMSV.Wla lama iertplalm�EIICItCALHMEIIi PERMR RRIVEWAYdrc(OBNe) <br />Contractor's License <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />1193 J"l FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: <br />�� Ate, <br />AREA: <br />57MAry✓ QUAD <br />TYPE: <br />jam ✓ c'>✓J <br />FORMS: <br />JIB -/7 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL: <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for per fission to excavate, construct and/or otherwise envy ; Yh9n County Hi y Ri t -of -Way on the <br />6X side of ;4yo approximately IMM e�mile <br />of � 499 �� by installing <br />Work will <br />commence on or about for approximately days. <br />01) Separate sheet may be submitted) <br />Will this project be self -installed? AYES NO <br />P.�FHLRCALHMCMSV.Wla lama iertplalm�EIICItCALHMEIIi PERMR RRIVEWAYdrc(OBNe) <br />Contractor's License <br />