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r <br /> COUNTY OF SAN dOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: I" <br /> APPLICANT OFFICE USE ONLY <br /> Name: u PCZ , <br /> Address: P,V13;& c-'N' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: G{NSWI APN /(x-23 FEE DUE: <br /> Area Code -Telephone Number: Wq- EXP.DATE: DRIVEWAYS: <br /> STREET: V.4aey Pie. <br /> SITE INFORMATION: AREA: 5-wMe em l QUAD <br /> Parcel Owner's Name: TYPE: �yJ <br /> Site Address: cilOck \16 FORMS: ./ <br /> City, State,Zip Code: \. NOTES: <br /> Area Code -Telephone Number: - 3.1�1,6 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: 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 to excavate,construct and/or otherwisewcroach on County H' way Right-of-Way on the <br /> view ' side of VA LL6y 1>9, approximately 7777 f e 500T14 <br /> Of N/lo&�aaA s c.J byinstalling DJV%1e .0AV <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 />