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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: (gdltllq A pi>Sj'1r 3ftirhi <br />Address: '. MA><A4�11_ <br />City, State, Zip Code: <br />Area Code - Telephone Number: 1 011110-1311 <br />, <br />Email: <br />nA <br />APN <br />0C,,r <br />EXP. DATE: <br />DRIVEWAYS: <br />SITE INFORMATION: <br />_O&V 20. <br />Parcel Owner's <br />Name: rh <br />TYPE: <br />0 <br />FORMS: <br />Ww, - Il <br />n h <br />j <br />Site <br />Address: <br />�W <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />City, State, Zip <br />Code: <br />Area Code - Tele <br />hone <br />Number: <br />INDUSTRIAL: <br />IA <br />�41Q::23jgq <br />@ WW <br />RESIDENCE: <br />CONTRACTOR <br />Name:Aov <br />PAVED FRONTAGE <br />LENGTH: <br />Address:161#0 <br />m <br />Ft. X WIDTH: <br />City,State, <br />Zi <br />Code: <br />L,0Aj,WbjC22 <br />42,, <br />Area Code - Telephone <br />Number: <br />Date: Io a zs <br />Received By: S� <br />CR#: O?7083 <br />The undersigned hereby applies for permission to excavateconstruct andl <br />, or otherwise encroach on County Hi hway Right -of -Way on the <br />t Jo�s1 side of PvirA 2j approximately ur fe Ile <br />of AgAm P e IZA by instal ing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? YES NO Contractor's License � (�J <br />ENGlpACHNENiflM1bsle�FameiempabalENGROACXMENf PEPMt ORNEWAY.ko)0808) <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />OL3- 15'0 - 3 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />_O&V 20. <br />AREA: <br />C,r.EPA4"S QUAD KE <br />TYPE: <br />0 <br />FORMS: <br />Ww, - Il <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ WW <br />RESIDENCE: <br />uj <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavateconstruct andl <br />, or otherwise encroach on County Hi hway Right -of -Way on the <br />t Jo�s1 side of PvirA 2j approximately ur fe Ile <br />of AgAm P e IZA by instal ing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? YES NO Contractor's License � (�J <br />ENGlpACHNENiflM1bsle�FameiempabalENGROACXMENf PEPMt ORNEWAY.ko)0808) <br />