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f,5-;-3Og-00& <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: 7i3.we_4 1 <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: ,9, o <br />Email: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: <br />CONTRACTOR <br />Name: <br />Address: <br />City <br />I Ste a. Zip Code: <br />Area Code -Telephone Number: <br />Date: <br />Received By: z_ <br />CR#: <br />The undersigned hereby applies or permission to excavate, construct and/or otherwise encroach on County bway Rip -of -Way on the <br />Gt/E5T side of rdGlf9 �O. approximately 9 e I mile sA.YN <br />Of 4 , by installing <br />Work will <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />t�ac <br />^Ielv A4 A4 <br />SFrt � <br />Za' wioE <br />E • � D,t�9y GoGoNy 2-v_ <br />Will this project be self -Installed? YES NO <br />xiaNNOAnwFxlsu,eurmm-r,vxi,awCnoncxu�rtrrnunonwnvnrex,caa� <br />Contractor's License <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APNGta'3-220 o FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: <br />1,6444D eD <br />AREA: <br />Cops QUAD A,0 <br />TYPE: <br />W <br />FORMS: <br />/7 <br />NOTES: <br />LAPO e u .4 <br />DRIVEWAY <br />TYPE: <br />QUANTITY WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />I Q RIW <br />RESIDENCE: <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies or permission to excavate, construct and/or otherwise encroach on County bway Rip -of -Way on the <br />Gt/E5T side of rdGlf9 �O. approximately 9 e I mile sA.YN <br />Of 4 , by installing <br />Work will <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />t�ac <br />^Ielv A4 A4 <br />SFrt � <br />Za' wioE <br />E • � D,t�9y GoGoNy 2-v_ <br />Will this project be self -Installed? YES NO <br />xiaNNOAnwFxlsu,eurmm-r,vxi,awCnoncxu�rtrrnunonwnvnrex,caa� <br />Contractor's License <br />