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COUNTY OF SAN JOAQUIN Date: �� <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: O e7, <br /> DRIVEWAYS AND PAVED FROTTAGES <br /> �1 , �w PERMIT APPLICATION <br /> APPL T OFFICE USE ONLY <br /> Name: v <br /> Address: Z 1 G JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN FEE DUE: <br /> Area Code -Telephone Number: p p 3 EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD S 4.7 <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 6 FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: lEgFRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission o e cavate,construct and/or otherwise encroach County Highway Ri ht-of-W on the <br /> side of 1 approximately feet/mile <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 _X_NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT ORIVEWAY.000 (09113) Page 1 of 2 <br />