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COUNTY OF SAN JOAQUIN Bate: _�=-�7-,�4_IS <br /> DEPARTMENT OF PULIC WORKS <br /> Received By:' <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Ga R kA SJ, JOB#: 11005 ISSUE DATE: <br /> ate,Zip Code: A"It'a VxLe r-a- G 4 5-S% APN C21 _ 3()- ] FEE DUE: <br /> ode -Tele hone Number: q_ ct _yZg. EXP.DATE: DRIVEWAYS:_ <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD - <br /> Wrior's Name: ;va,,rv� v� „;,& LL TYPE: <br /> ress: ( FORMS: <br /> te,Zip Code: NOTES: <br /> le -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: CiUANTITY WIDTHS <br /> rL <br /> N�oayto..' s v�. AGRICULTURE: <br /> S < Aw-�_ COMMERCIAL• @FRONTAGE <br /> Zip Code: /Vl, 1.« INDUSTRIAL: @ RNII <br /> e -Telephone Number: Q _ _ RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> dersigned hereby applies for permi sion to e cavate,construct and/or otherwise encroach qqn County Hi way Right-of-Way on the <br /> side ofj Q GCYI _approximately z s U ee mile <br /> by installing <br /> .ice on or aboutfor approximately Work will <br /> days. <br /> �H(Separate sheet may be submitted) <br /> ,olect be self-installed? YES NO Contractor's License <br /> VI/�FC1f:l FRIrAl 1Pl IR_CI/InlvltiA cryo nn r..n,,.,.,.•..�..-..-_..�___.__...._ <br />