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COUNTY OF SAN JOAQUIN Date: <br /> . ARTMENT OF PUBLIC WORKS Received by <br /> 0WVEWAY& PAVED FRONTAGES • CR#__ v <br /> PERMIT APPLICATION v® <br /> APPLICANT <br /> OFFICE USE ONLY <br /> Nam g JOB# 110D5 ISSUE DATE /4. <br /> APN FEE DUE <br /> ( Addres _ EXP DATE DRIVEWAYS <br /> �.. aCYt•P ct •2�wf <br /> STREET <br /> --T <br /> City,state-Zip C, a AREAQUAD <br /> r'7 2*Y 'S"7 U TYPE1�, /G�t�r^✓ ,r <br /> (Area Code)Telephone FORMS <br /> • NOTE <br /> ITE INFORMATION <br /> Y,tA.- <br /> Parcel Owners Name DRIVEWAY <br /> Site 'esb TYPE QUANTITY WIDTHS <br /> e- ( C AGRICULTURE @ FRONTAGE <br /> ity,state-Zip Code COMMERCIAL <br /> Z4,)g--7 Z7 – �C3 INDUSTRIAL _ @ R/VJ <br /> (Area Code)Telephone RESIDENCE: <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> dd t- s <br /> .q '2 Q The undersigned hereby applies for permission to encroach <br /> City,STate-Zip Code on County Highway Right-of-Way on the FsT— side of <br /> 3-3 4 _ Q 7ct cD approximately <br /> (Area Code)Telephone ft t J t e S0u7.0 of <br /> by installing <br /> arP/y-ef--ua/s-y <br /> Work will Commence on or about Z S'— _for approximately d9 0 days. <br /> SKETCH (Separate sheet may be submitted) <br /> �t <br /> Will this project be self-installed? NO YES Contractor s License <br />