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-COUNTY OF SAN JOAOUIN Date; 4Cp �1-4/'!!;� <br /> DEPARTMENT OF PULIC WORKS <br /> Received By <br /> DRIVEWAYS AND PANED FRONTAGES <br /> PERMIT API3LI TION , 'CR#:���r g' <br /> APPLICANT OFFICE USE ONLY <br /> Name: ;n <br /> Address: ;, --, ] .' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: -'I; n <br /> 74J APN <br /> r`�}T—� FEE DUE: <br /> Area Code -Telephone Number EXP.DATE: DRIVEWAYS: <br /> STREET: rw rLln.im Qty <br /> SITE INFORMATION: AREA: QUAD - <br /> Parcel Owner's Name:.` t,' ,, -),Y,- 11 ,� >'C TYPE: , ,`, <br /> Site Address: ? rr -, FORMS: <br /> City,State,Zip Code: ? > NOTES: <br /> Area Code -Telephone Number: 7 - LJ <] <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: f AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/VV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T e and rs'gned hereby applies for permission to excav f ,cons uct and/or otherwise e croach in CounMfee <br /> y ght-of- yon the <br /> side of approximately_ . �C) ile <br /> �- 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 NO Contractor's License <br /> M10ENTRALSERVICESICLERICALIPU&SV.WK4MASTERPSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page l of 2 <br />