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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T C <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 3 6 <br /> APPLICANT OFFICE USE ONLY <br /> Name: ` <br /> Address: JOB#: 11005 ISSUE DATE: <br /> Ci ,State,Zip Code: , - APN - t zO-l( FEE DUE: <br /> Area Code -Telephone umber: Z - p EXP.DATE: 1 -2, - ( DRIVEWAYS: <br /> STREET: F�(f rG 6, <br /> SITE INFORMATION: AREA: �/C-���h QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: FORMS: s 1a kV 0 I <br /> City,State,Zip Co e: i5 NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: w • AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission o excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> Q/ side of r C16A approximately Z /M feet/mile <br /> of e e c. er by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> 1 <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:4CENTRALSERVICES\CLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRNEWAY.DOC (09113) Page 1 of 2 <br />