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- COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: Cbtg <br /> APPLICANT OFFICE USE ONLY <br /> Name: ^ c <br /> Address JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: illct,C y 7) APN `�j��-($p_2 j FEE DUE: <br /> Area Code -Tele hone Number: 4 1 �� EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: Fry��'R• QUAD SE. <br /> Parcel Owner's Name: Zzzz -0 TYPE: <br /> Site Address: FORMS: 59 u1 VU71 <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY.. <br /> — --- -- - CONTRACTOR----- - ---- - -TYPE. --.-_ --QUANTITY--- --- -- - WIDTHS <br /> Name: ( ,v c,,v�) , AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Nu ber.L RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. . X WIDTH- Ft. <br /> Th undersigned hereby applie for per ission to excavate,construct and/or otherwise encroach on County ' way Rigght-of-Way on the <br /> _side ofapproximately 2Oc�� fee mile Joy <br /> of by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES VNO Contractor's License <br /> M.ICENTRALSERVI0ESICLERICALIPUB-SV.WKIMASTER.PS%ENCROACHMENT PERMIT OR4VEWAY.000 (09113) Page 1 of 2 <br />