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COUNTY OF SAN JOAQUIN ©ate: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: 7- ( <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:_ <br /> APPLICANT L5. OFFICE USE ONLY <br /> Name: - <br /> - <br /> Address: 0 '^ S JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: _ c APN <br /> 7 r'I c150 (� FEE DUE: <br /> Area Code -Telephone Number: 5 L EXP.DATE: >01C DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD 4Z — <br /> Parcel Owner's Name: / TYPE: <br /> Site Address: � ? r- FORMS: Iy <br /> Ci ,State,Zi Code: �� orlNOTES: <br /> Area Code -Telephone Number: o / of <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> dame: _ Xj <br /> AGRICULTURE: @FRONTAGE <br /> address: COMMERCIAL: f/ <br /> ;ity,State,Zip Code: 30/ INDUSTRIAL: @ RNV <br /> lrea Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The unders'gned hereby applies for permission to excavate,construct and/or otherwise encroao on County Hi ay Right-of-Way on the <br /> side ofo ild en r approximately ��Z(1 ee ilei_ <br /> ofrto by installing <br /> commence on or aboutWork will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Vill this project be self-installed? _ YES NO Contractor's License <br /> CENTRALSERVICESICLERICALTU6-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />