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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTA(zE y <br />PERMIT APPLICATION <br />APPLICANT <br />Name; 'l '_ , <br />JOB #: <br />Address: 5D U3V��W`T=:\ <br />City, State, Zip Code: �' C �-- <br />Area Code - Telephone Number:/'7 <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: ( ' \ x . c <br />City, tate, Zip Code: jL <br />Area Code - Telephone <br />TYPE: <br />umber: -~ r - <br />CONTRACTOR <br />Name: <br />Address: `n ', D G�T7 i, _t <br />City, State, Zip Code: <br />DRIVEWAY <br />Area Code Telephone Number: c'-M�;;r( <br />c^_ <br />Received By: <br />The undersigned hereby applies for ermission to excavate, construct andlor otherwise encroach on County Highway Right -of --Way on the <br />&z2L1. side of ,rd%'%�Cicapproximately feetlmile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />i <br />Will this project be self -installed? �! YES NO Contracfor's License <br />P:IENOROACHMEMiIMasler Forms-Templatesl=NCROI+C:fIMEFR PERMIT �RIVHN.4Y.doc (U810BJ <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 1) b??R,7 D z o 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 undersigned hereby applies for ermission to excavate, construct andlor otherwise encroach on County Highway Right -of --Way on the <br />&z2L1. side of ,rd%'%�Cicapproximately feetlmile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />i <br />Will this project be self -installed? �! YES NO Contracfor's License <br />P:IENOROACHMEMiIMasler Forms-Templatesl=NCROI+C:fIMEFR PERMIT �RIVHN.4Y.doc (U810BJ <br />days. <br />Work will <br />