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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: <br />'Ilk <br />JOB #: <br />11005 ISSUE DATE: <br />Address: O oe <br />CC) 10 <br />City, State, Zip Code: <br />EXP. DATE: <br />2 <br />Area Code -Telephone <br />Number: <br />AREA: <br />LyD/ QUAD 1W <br />—Pv <br />TYPE: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />FORMS: <br />Site Address: Ia <br />(� <br />City, State, Zip Code: C6q <br />DRIVEWAY <br />Area Code -Telephone Number: <br />TYPE: <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code <br />- Telephone <br />li @FRONTAGE <br />Number: <br />i <br />Date: _ 49!7 j 12,0 <br />Received By: <br />cRa: r?�7353 <br />The undersigned hereby applies for permission to excavate, construct and/or othenn�ise encroach on County Hic y Right -of -Way on the <br />A/OA2T7� side of Tkry approximately 5'd a dem <br />of Jai c r 160- 1 by installing <br />commence on or about <br />may be submitted) <br />_. Will this project beself-installed? YES NO <br />P:IENCROAGIMENFSdMaaNr FannsiempaNaIENCROACNMENFPERMIi ORNEWAY.da (ObllB) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />PN .2. -J FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: 7ZKAy iroboxlv APO <br />AREA: <br />LyD/ QUAD 1W <br />TYPE: <br />FORMS: <br />N!✓ iP / <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />li @FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL: <br />@RM <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />R. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or othenn�ise encroach on County Hic y Right -of -Way on the <br />A/OA2T7� side of Tkry approximately 5'd a dem <br />of Jai c r 160- 1 by installing <br />commence on or about <br />may be submitted) <br />_. Will this project beself-installed? YES NO <br />P:IENCROAGIMENFSdMaaNr FannsiempaNaIENCROACNMENFPERMIi ORNEWAY.da (ObllB) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />