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( M1 <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPART MENT OF PULIC WORKS <br /> Received By: i <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 7 15 U j <br /> APPLICA OFFICE USE ONLY <br /> Name: ilG <br /> Address: C7 +- JOB : 11005_ ISSUE DATE: <br /> City,State,Zip Coda: - APNFEE DUE: <br /> Area Code -Telephone umbe EXP.DATE: DRIVEWAYS. <br /> STREET: Vr,1 r r o P&r' <br /> SITE INFORMA ION: AREA: T,- v QUAD 5 y✓ <br /> Parcel Owne's Name: I TYPE: I>r r rte, , _ <br /> Site Address: W, 1/ G�+ FORMS: S / /l.� Q -17 <br /> City,State,Zi Code: C+ NOTES: <br /> Area Code -Telephone Number. <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name' <br /> G�� v _[AJC . AGRICULTURE: FRONTAGE <br /> Addre �. to 4 COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL.: I 6RNV <br /> Area Code -Tele hone Number RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appllgs for ppeerrmtssion to excavate,construct and/or otherwise encroach on County High. Right of-Way on the <br /> QC"k side of W. fox <br /> -P�c approximately f fee mil <br /> of L<Alm Nr(ypz �__,_ by installin <br /> Work will <br /> commence on or aboutfor approximately ® days. <br /> SKETCH(Separate sheet may be submitted) <br /> WIll this project be self-installed? YES , NO Contractor's License <br /> 4.t1L'ENI RALSERVlCE51ClL-Ti1CALVUD-SV.WKVhASTER.PSIEtr'CROACHM£MT PEfLM'tT ORi4LWr\Y.4Vl: (OEIt3i Paget e.2 ' <br />