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COUNTY OF SAN JOAQUIN Date:_/ <br /> SAR T M=NT OF PUSLIC Vv3RKS . Received' by <br /> DRIVEWAY & PAVED FRONTAGES CR# Oo J 7 S <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> cll <br /> ISSUE DATE <br /> N � f <br /> a me JOB 4"111005'�1 <br /> APN�- O - FEE DUE <br /> Aocress EXP. DATE 7/ DRIVEV,/AYS: <br /> _ __..... <br /> , . <br /> C1 �. STREET <br /> i!y`State-Z;p code AREA QUAD Sri <br /> 3 TYPE <br /> J <br /> (Area Cate)Telep�o e FORMS <br /> NOTE <br /> SITE INFORMATION <br /> i <br /> �J DRIVEWAY <br /> Parcel owner's Name <br /> Site Address TYPE QUANTITY WIDTHS <br /> �- [\(� \ C', CA �`, AGR!C�JLTURE Q FRONTAL =ja <br /> cidy.state-Zip Code COMMERCIAL <br /> INDUSTRIAL @F;LW <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name LENGTH: VM= Ft. X WIDTH: Ft. <br /> Adress <br /> �` Cl -S3The undersigned hereby applies for permission to encroach <br /> city,state-zip code on County Highway Right-of-Way on the aLside of <br /> C ` \-c S."-t '� C- � - approximately <br /> (Area Code)Telephone -\S _feet/mile of <br /> by installing ? r <br /> VYoA will commence on or about AD \ 4 for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> f ` C_i �� 1 <br /> I <br /> NO YES Co—av'er's Lice rse L� <br />