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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />fJRIVEWAYS AND PAVED I RKUN IAtaES <br />PERMIT APPLICATION <br />The ndersigned hereby appl <br />O N side of <br />of G/Vwkxw4,. am <br />commence on or about <br />Date: <br />Received By: <br />APPLICANT <br />Gt -C6OLS <br />11005 ISSUE DATE: <br />Name: <br />I FEE DUE: <br />it <br />S <br />STREET: <br />Address: <br />bre <br />roo QUAD <br />TYPE:�-s <br />City, State, Zi <br />Code: % <br />S� 7 <br />2 <br />Area Code - Telephone Number: --&G `7-8. <br />7 <br />SITE INFORMATION: <br />QUANTITY <br />WIDTHS <br />Parcel Owner's <br />Name: <br />@FRONTAGE <br />(kvnCcA <br />34 <br />Site Address: <br />6Cosnoo V, " q <br />RESIDENCE: <br />City, State, Zip <br />Code: 2.a I vmp <br />LENGTH: <br />Area Code - Telephone Number: QOS',,10 <br />1 <br />Ft. X WIDTH: <br />CONTRACTOR <br />Fte <br />Name: <br />- <br />S <br />Address: <br />-2 b i <br />ct <br />City, State, Zip <br />Code:c - <br />S 3 i <br />Area Code <br />- Telephone <br />Number: <br />•7- "t <br />The ndersigned hereby appl <br />O N side of <br />of G/Vwkxw4,. am <br />commence on or about <br />Date: <br />Received By: <br />for permiss'on to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />/ approximately He �T <br />h �J , by installing <br />SKETCH (Separate sheet may be submitted) <br />� Will this project be self -installed? YES NO <br />P:IENCROACHMENTSIhlasler Fertns-TemplaleslENCRDACHMENT PERMIT DRIVEWAY.dac (08108) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN f Gj <br />I FEE DUE: <br />EXP. DATE: <br />Z6��09 <br />DRIVEWAYS: <br />STREET: <br />Magi 1& <br />AREA: <br />roo QUAD <br />TYPE:�-s <br />FORMS: <br />r;J ,Q <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RM <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Fte <br />for permiss'on to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />/ approximately He �T <br />h �J , by installing <br />SKETCH (Separate sheet may be submitted) <br />� Will this project be self -installed? YES NO <br />P:IENCROACHMENTSIhlasler Fertns-TemplaleslENCRDACHMENT PERMIT DRIVEWAY.dac (08108) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />