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COUNTY OF SAN JOAQUINV Date: �Z Gt <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: C.2--W LI <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APNFEE DUE: <br /> Area Code -Tele hone Number. EXP.DATE: DRIVEWAYS: <br /> Y 17 <br /> 3 36 3� STREET: S <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: Ory e--, TYPE: <br /> Site Address: FORMS: t j6—Cl <br /> City,State,Zip Code: ,` NOTES: <br /> Area Code -Telephone Number: �y cl q3 37 <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITYWIDTHS <br /> Name: Sfq r O G�� AGRICULTURE: @FRONTAGE <br /> Address: % '10 COMMERCIAL: <br /> City,State,Zip Code: Q q 7 INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: 3;7y 6 q7,?— RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway R�i ht.-of,-Way on the <br /> side of _ approximately � C�C�I feet/mile <br /> of ,by installing <br /> Work will <br /> commence on or about for approxim ately days. <br /> SKETCH(Separate sheet may be submitted) <br /> f Will this project be self-installed? YES NO Contractor's License --� ,--� <br /> �a <br /> M.ICENTRALSERVICESICLERICALTU&SV.WKWASTER.PSIENCROACHMENTPERMR ORIVEWAYAOC (09113) Page 1 of 2 <br />