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• COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <' <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> Name: <br /> APPLICANT OFFICE USE ONLY <br /> tr 1�ti :; -y,. <br /> Address: r i.; { JOB#. 11005 ISSUE DATE: <br /> City,State,Zip Code: APN �Ty 7 3 t) FEE DUE: <br /> Area Code -Telephone Number . , EXP.DAT E: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: ! c{inn QUAD — - <br /> Parcel Owner's Name: �,, ,,� — ,.c �.� r, TYPE: <br /> Site Address: ,; - �r 1!> FORMS: <br /> City,State,Zil Code: i,/-I-I NOTES: <br /> Area Code -Telephone Number <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE_: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R(W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft,. <br /> The unde ign�d hereby applies for per fission to excavate,construct aidlor otherwise encroach o County Hi way Right-of-Way on the <br /> fide of Y l Ln —approximately_ fee mile_ <br /> of 711 Fey by installing <br /> commence on or aboutWork will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Con`ractor's License <br /> d:ICENTRALSERVICESICLERICAL%PU&SV.VVMMASTER-P&egCROACHMEN'TPERMITDRIVEWAY.DOC (09113) Page 1 of 2 <br />