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:Yg�,�,..� ••- � <br /> `;. COUNTY OF SAN JOAOUIN Date: / <br /> OPAR T MENT OF PUBLIC 'v'JGRKS Received by <br /> DRIVEWAY & PAVED FRONTAGES CR# 4oa - �;2- <br /> PERMIT APPLICATION <br /> I <br /> APPLICANT <br /> OFFICE USE ONLY <br /> JOB # 11005 ISSUE DATE 1 �_ <br /> game JOB <br /> IgE -6,196 Z FEE DUE <br /> Z I Lv <br /> Andress EXP DATE � �,... DRNEWAYS: .•.. _ :. <br /> STREET <br /> City,state-Zip Code <br /> AREA OI.QUAD=.• <br /> TYPE- <br /> (Area <br /> YPE(Area Code)Telephone FORMS ss f 7 <br /> NOTE...;, .. <br /> SITE INFORMATION <br /> J DRIVEWAY <br /> Parcel Owner's Name <br /> Site Address TYPE QUANTITY WIDTHS <br /> I <br /> AGRICULTURE @ FRONTAGE <br /> C'ry,State-Zip Code COMMERCIAL <br /> INDUSTRIAL @ RIW <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Named LENGTH: Ft. X WIDTH: Ft. <br /> Al- <br /> ddress <br /> The undersigned hereby applies for permissl n to encroach <br /> ,-- Cly,stale-Zip Code on County Highway Right-of-Way on the _side of <br /> `Rd� approximately <br /> {Area Code)Telephone / ooh fee mile r/ %� of <br /> a,Z by installing <br /> Work will commence on or about for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> `_� poi 7s I N <br /> .,...;pc-e be cp,f-ins?aped? NO <br /> YES Con?rac?or's License <br /> r' <br />