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COUNTY OF SAN JOAQUIN <br />DEPAI;"IMViENT OF PUI_IC WORKS <br />DFti1 MINAYv) A(`ILr PAVU.) t✓IIUPI C,� GI <br />PERMIT' APPLICt1 HON <br />NPPLICAN"( <br />Name: ,t/ , ) <br />Address: <br />City, State, Zip Code: <br />Area Code Telephone Numb <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: L ^A df <br />City, State, Zip Code: �L� �f ,�,ry' 2= a <br />Area Code - Telephone Numb <br />�. <br />CONTRACTOR <br />Name; v 6�9 <br />Address: <br />City, State, Zip Code; <br />Area Code - Telephone Number: <br />Date: <br />Received By: <br />C <br />The undersigned hereby applies for permission to e>;cavate, construct and/or othery✓ise encroach on County Highway Right-of-UVay on the <br />side of approximately _ feetlmila <br />of by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />P:iENCFtUACH:dEldl'SIIJaslcr Fnrmo-Tamplalc�lEPI�fCOf;CH1.fE11T PEF9/,CF UFOVEN'AY.ior. (UENUi <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE; <br />APN <br />_ <br />ew, FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />'r.- :f2i-= <br />AREA: <br />°�d���{ :� QUAD X/lii r <br />FORMS: <br />k r' <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />,FRONTAGE <br />COMMERCIAL: <br />IIVDUSTRIAL: <br />@ R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to e>;cavate, construct and/or othery✓ise encroach on County Highway Right-of-UVay on the <br />side of approximately _ feetlmila <br />of by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />P:iENCFtUACH:dEldl'SIIJaslcr Fnrmo-Tamplalc�lEPI�fCOf;CH1.fE11T PEF9/,CF UFOVEN'AY.ior. (UENUi <br />