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COUNTY OF SAN JOAQAUII�N Dater <br /> DLFARTIVALIV-t Vl�I�VLIC YV�l1R � <br /> Received By: AIAZ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 4077 ' <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: '1V&:Z ",I YCI JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: to n 2 APN / 1y. patr FEE DUE: <br /> Area Code -Telephone Number•' � _3.Q 2— EXP:DATE: r DRNEWAYS: <br /> STREET: - <br /> SITE INFORMATION: AREA: � QUAD <br /> Parcel Owner's Name: o �. TYPE: <br /> Site Address: ,/ - _ 4 pg ' Lir- FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Numbe car !—3 7z <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: r AGRICULTURE: 0FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RfW <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 otherwise encroach on County y Right-of-Way on the <br /> "MOT-1441 side of "D.q ,411E approximately j <br /> of_'5!g Lc ev 40W ,by instafCng <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 /> Y:VURMS 8 TEMPlATE51ENCROACNMENT PERMIT ORIVEWAY.doc(06x]8) <br />