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COUNTY OF SAN JOAQUIN Date: 3 <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGE Received By: <br /> PERMIT APPLICATION CR#: <br /> APPLI ANT OFFICE USE ONLY <br /> Name: - <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN ( () Zj FEE DUE: <br /> Area Code -Tele hone Number: - EXP.DATE: DRIVEWAYS: <br /> STREET: D tefri ch <br /> SIT NFORMATION: AREA: (_rnG'L/L QUAD [— <br /> Parcel Owner's Name: TYPE: <br /> Site Address: &I FORMS: S I <br /> City,State,Zip Code: NOTES: <br /> Area Code -Tele hone Number: <br /> DRIVEWAY, <br /> If CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: a n. p AGRICULTURE: __J@FRONTAGE <br /> Address COMMERCIAL: <br /> City,State,Zip Code: �' INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: 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 Hi way Right-of-Way on the <br /> side of approximately `z-UfJ ee ile <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 NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALTU&SV.WKIMASTER.PSIENCROACHMENT PERMIT ORIVEWAY.000 (09113) Page 1 of 2 <br />