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A <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DKIVEWAYS AND PAVED FRONTAUtO <br />PERMIT APPLICATION <br />'�-� <br />Uate: <br />Received By: <br />APPLICANT <br />JOB #: <br />Name: wut <br />VUL, <br />J, W1V".T e.. <br />DRIVEWAYS: <br />Address: <br />do 0.'C. <br />AREA: <br />City, State, Zip Code: <br />Vo l %c <br />"7 <br />Area Code - Telephone <br />Number: 6 o <br />NOTES: <br />SITE INFORMATION: <br />DRIVEWAY <br />Parcel Owner's Name: <br />e, 5a 1%/ <br />QUANTITY <br />Site Address: <br />AGRICULTURE: <br />City, State, Zip Code: <br />@FRONTAGE <br />COMMERCIAL: <br />Area Code - Telephone <br />Number: <br />@ R/W <br />CONTRACTOR <br />Name: <br />hc�v <br />o <br />Address: <br />City, State, Zip Code: <br />Area Code "Telephone <br />Number: <br />.),o 9 — ((Sl i <br />-g 7 <br />'�-� <br />Uate: <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />sideof Cia`nher 5 }r*ew-wr approximately :0© Ari feeUMM <br />of f=t a Ci j °�� r�(_. by installing - , <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet maybe submitted) <br />�C, <br />Z <br />y-- <br />Will this project be self -installed? _YES NO <br />PiIENCRDACHIdEMaddaskr Fotms-TemplaleslENCRDACHMENT PERMIT DRIVEN/AY.doc (08108) <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN� 055-3uo. 42 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />6t.1+se,ep St <br />AREA: <br />0s QUAD �✓ <br />TYPE: <br />, <br />i <br />FORMS: <br />f 04mf _A A07 <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: Ftb <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />sideof Cia`nher 5 }r*ew-wr approximately :0© Ari feeUMM <br />of f=t a Ci j °�� r�(_. by installing - , <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet maybe submitted) <br />�C, <br />Z <br />y-- <br />Will this project be self -installed? _YES NO <br />PiIENCRDACHIdEMaddaskr Fotms-TemplaleslENCRDACHMENT PERMIT DRIVEN/AY.doc (08108) <br />Contractor's License <br />days. <br />Work will <br />