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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PLILIC WORKS <br />'VVI ('Z) ANLI I f1 rml) I luilN I Af�F[ <br />PERMIT APPLICATION <br />Date: <br />Received b}+: <br />c <br />APPLICANT <br />Name: <br />11005 ISSUE DATE: <br />Address: <br />City, State, Zip Cocle: <br />- �t� .. ` lv!s i <br />Area Code - Telephone <br />Number:.v�-A ���� - .o <br />EXP. DATE: <br />SITE INFORMATION: <br />Parcel Owner's Name:. <br />- <br />Site Address: q. <�, t\-, <br />City, tate,Zi) Code: s� . c ie,::zc;l� ca,,, ck5 c �, <br />Area Code - Telephone <br />Number�� <br />.,la. <br />CONTRACTOR <br />Name: <br />Address: <br />NOTES: <br />City, State, Zip Code: <br />Area Code <br />- Telephone <br />TYPE: <br />Number: <br />Date: <br />Received b}+: <br />c <br />The undersigned hereby applies for permission to excavate, construct and/or otheitivise encroach on County Highway Right-of-VUay on the <br />side of approximately .1, *%. feetmmile, <br />of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />��� 'JUill this project be self -installed? _a_„�_`r''ES _.NO <br />P:ISIdCRC1ACHl/.ENTSIL'ac;cr Porr;tsTempic!zal9!CRO/.L;44::i:TP°RIdR GRP'c:'L'".doc (Cf.10") <br />for approximately <br />Contraci:or's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />f'ti IV* I"c FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />� ,ri+�er►t <br />AREA:��.; <br />i, i u H l QUAD *'5'a -'"s `. <br />TYPE: <br />.,la. <br />FORMS: <br />Lr� 17 — <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RAN <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otheitivise encroach on County Highway Right-of-VUay on the <br />side of approximately .1, *%. feetmmile, <br />of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />��� 'JUill this project be self -installed? _a_„�_`r''ES _.NO <br />P:ISIdCRC1ACHl/.ENTSIL'ac;cr Porr;tsTempic!zal9!CRO/.L;44::i:TP°RIdR GRP'c:'L'".doc (Cf.10") <br />for approximately <br />Contraci:or's License <br />days. <br />Work will <br />