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COUNTY OF SAN JOAQUIN ' I_ <br /> Date; <br /> DEPARTMENT OF PULIC WORKS 4_ <br /> C (C DRQ By: '_. <br /> �������AND PAVED � Received -r r <br /> PERMIT APPL►CATIQIq <br /> APPLICANT S- S Z� ------_ <br /> Name: OFFICE USE ONLY <br /> Address: y <br /> Cify,Stafe,Zip Cade: T " JOB#: 1105 <br /> Area Code -Tele hone Number. 64 R iec i 0 APN ISSUE DATE: <br /> 7 EXP.DATE: 1 !'� FEE DUE: <br /> STREET: DRIVEWAYS: <br /> Parcel Owner's Name:p TEINFORMATION: —� <br /> AREA: QUAD <br /> Site Address:` '' - TYPE: <br /> !cc z �L) i- A tie <br /> Ci!y,State,Zi Code: FORMS: S <br /> Area Code -Telephone Number.- G 4 _ 2 NOTES: <br /> fo <br /> CONTRACTOR DRIVEWAY <br /> Name: r_- _ TYPE: QUANTITY <br /> Address: AGRICULTURE: WIDTHS <br /> City,State,Zip <br /> ' �' @FRONTAGE <br /> Code: p COMMERCIAL: <br /> Area Code -Telephone Number. INDUSTRIAL: <br /> 730 RESIDENCE: @ RNV <br /> PAVED FRONTAGE <br /> LENGTH: •Ff. X WIDTH: <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on C linty Highway Ft. <br /> side of g y Rlght of Way o <br /> of __ �-1, t, '" approximately_ ch o Y n the <br /> by installing feet/mile <br /> commence on or about <br /> for approximately Work will <br /> rIKETCHarate sheet may be submiffed) days. <br /> _ <br /> P <br /> I <br /> er= �Krc rvla CMS 1 <br /> I WA 1,T EW�}7 E"2-_ <br /> 1 ?L Au <br /> Will this project be self-installed? YES <br /> _._NO Contractor's License <br /> ICEMRALSERV10ESlCLERICALIPU9_SV.wKWASTEFt IEryCRDACHMENTPERMlTDRNEWAY.DDC (09173) <br /> Page 1 of 2 <br />