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Xo3/3Z <br />COUNTY OF SAN JOAQUIN j Date: // 2 tl <br />DEPARTMENT OF PULIC WORKS <br />Received By: <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION CR#: D%ZrXo% <br />APPLIC T <br />Name: ,D7ay6}/r! , E <br />Address: <br />City, Slate, Zip Code: Y ' C a <br />Area Code - Telephone Number: <br />SITE INFORMATION: <br />Parcel Owner's Name: C <br />Site Address: / _ 3 e tc <br />City, State, Zip Code: ' C's. <br />Area Code - Tele hone Number: is <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: <br />The undersigned hereby appli s for permission to excavate, construct and/or otherwise encroach on County H' ay Ri -of-Way on the <br />side of i.Cry� / approximately f mile <br />ooyi+ern , by installing <br />commence on or about <br />for approximately <br />sheet may be submitted) 3-- <br />QL n 1 1 S k y e <br />Will this project be self -installed? YES Pl"�_NO Contractor's License <br />RIEHCROACHMEIRNIasI,r F. -T4 plaPMROACHMEIIT PER MIT ORNEWAY.(080) <br />days. <br />Jir(.]RTMI <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN Qbl FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: 9W <br />tl Al AP <br />AREA: Zpo <br />QUAD Alf <br />TYPE:�A�cl� <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />K <br />INDUSTRIAL: <br />RNV <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Fl. <br />The undersigned hereby appli s for permission to excavate, construct and/or otherwise encroach on County H' ay Ri -of-Way on the <br />side of i.Cry� / approximately f mile <br />ooyi+ern , by installing <br />commence on or about <br />for approximately <br />sheet may be submitted) 3-- <br />QL n 1 1 S k y e <br />Will this project be self -installed? YES Pl"�_NO Contractor's License <br />RIEHCROACHMEIRNIasI,r F. -T4 plaPMROACHMEIIT PER MIT ORNEWAY.(080) <br />days. <br />Jir(.]RTMI <br />