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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />I1FZI1/le;'t' AYS AND PAVED F410tZ NTri GES <br />I'l R.II.IfIT APPLICATION <br />APPLICANT <br />Name: <br />` <br />u lroo" et <br />.-filkimpt <br />(961 ; Z: j 4 ' FEE DUE: <br />EXP. DATE: <br />Address: Vii, <br />r" c "falba '' Wad <br />AREA: <br />City, State, Zip Code: ;`a�; l rp X5;20 <br />r <br />Area Code Telephone Number: "i P. �JZ J�ej <br />SITE INFORMATION: <br />Parcel Owner's Name:<�ar� 1411'.@1 <br />POW <br />Site Address: 0 c.; .rv�%Ei'I.%ga lV%i" <br />City, State Zip Code:g <br />Area Code Telephone Number:' <br />/ <br />CONTRACTOR <br />Name: <br />, <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Date. ==.j <br />Received By; / <br />I he unclersigneci hereby applies for permission to excavate, construct andlor otherwise encroach on Coi.)nty Highway Right -of -Way on the <br />side of approximately feet/mile <br />_ of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />1Nor1< will <br />� ( VVill this project be self -installed? . `� YES �__PJU Contractor's License _ <br />XAE1ICR0ACHIAE41 StMasler Fomrs-lemplaleEIEldGROAGHMEIVI PFRINT DRIVEWAY dcc (98/7F) <br />OFFICE USE ONLY <br />JOB f#: <br />11005 ISSUE DATE: <br />APN <br />(961 ; Z: j 4 ' FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET:, <br />AREA: <br />y�f <br />Lj caZi QUAD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RM <br />RESIDENCE: <br />Lk <br />PAVED FRONTAGE <br />LENGTH: <br />FL X WIDTH: Ft, <br />I he unclersigneci hereby applies for permission to excavate, construct andlor otherwise encroach on Coi.)nty Highway Right -of -Way on the <br />side of approximately feet/mile <br />_ of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />1Nor1< will <br />� ( VVill this project be self -installed? . `� YES �__PJU Contractor's License _ <br />XAE1ICR0ACHIAE41 StMasler Fomrs-lemplaleEIEldGROAGHMEIVI PFRINT DRIVEWAY dcc (98/7F) <br />