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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> APPLICANT <br /> Name: t�� rSne4 e r OFFICE USE ONLY_ <br /> Address: Zc<r2kf At K JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: ,y,Pv, C'.°t g�i APN (,10?310 2S FEE DUE: <br /> Area Code -Tele hone Number: EXP.DATE: <br /> DRIVEWAYS: <br /> STREET: E�,q <br /> SITE INFORMATION: AREA: y�� QUAD V,6Parcel Owner's Name: vC <br /> , r s TYPE: <br /> Site Address: �/ c2ct FORMS: LvW �7 <br /> City,State,Zi Code: r,�o C_vg S NOTES: <br /> Area Code -Tele hone Number: , _ 3 9-,3 i <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY <br /> Name: AGRICULTURE: WIDTHS <br /> Address: COMMERCIAL: @FRONTAGE <br /> ;ity,State,Zip Code: �� <br /> area Code -Telephone Number INDUSTRIAL: @ R/VV <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The <br /> undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Right- f-Way on the <br /> Of T,+qiy�g& -dip,$ �u� Rte° approximately ZGri z <br /> 44_ M� by installing 7.5c <br /> commence on or about for approximately Work will <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> 0:%CENTRALSERVICESICLERICALTUB-SV.WK%MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) <br /> Page i of 2 <br />