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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />OC n�G2 r) <br />APPLICANT <br />OFFICE USE ONLY <br />JOB #: <br />Name: 4 t <br />u <br />ticn <br />EXP. DATE: <br />DRIVEWAYS: <br />Address: 3S17 <br />Mo eW Aue. <br />QUAD <br />TYPE: <br />City, State, Zip Code: <br />q <br />Zv <br />Area Code -Tele <br />hone Number: Q q <br />aU�i9 <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />Email: <br />FRONTAGE <br />COMMERCIAL: <br />ov n <br />SITE INFORMATION: <br />@ R/W <br />RESIDENCE: <br />Parcel <br />Owner's Na me: L' <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />n <br />' <br />Site Address: J <br />e <br />v <br />Cit , State, Zi Code: ' <br />9 <br />S ZU 6 <br />Area Code -Telephone Number: 209 <br />2 010 W <br />@BPW�R46T-�- <br />Name: <br />Address: YH eK <br />City, State, Zip Code: C <br />R <br />20 <br />Area Code -Telephone Number: 24q 4a/- W�7 <br />Date: <br />Received By: <br />CR#: <br />The under igned hereby appligs for per�nis$)o to a cavate, construct and/or otherwise encroach on C unty High�ay Ri h -of- yon the <br />side of Plvv `0 approximatelyu ((a mile <br />ofAt& , by installing w vee , t 4aMeY� <br />commence on or about � /� <br />r <'-' <br />Will this project be self -installed? YES NO <br />%�ENCROACHMEMSIIAaakr FormaTemplateslENCR0ACHIAEM PERNR NRNE44AY.dm (OANB) <br />for approximately <br />SKETCH (Separate sheet may be <br />_ <br />141 <br />Contractor's License <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL <br />@ R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The under igned hereby appligs for per�nis$)o to a cavate, construct and/or otherwise encroach on C unty High�ay Ri h -of- yon the <br />side of Plvv `0 approximatelyu ((a mile <br />ofAt& , by installing w vee , t 4aMeY� <br />commence on or about � /� <br />r <'-' <br />Will this project be self -installed? YES NO <br />%�ENCROACHMEMSIIAaakr FormaTemplateslENCR0ACHIAEM PERNR NRNE44AY.dm (OANB) <br />for approximately <br />SKETCH (Separate sheet may be <br />_ <br />141 <br />Contractor's License <br />Work will <br />