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COUNTY OF SAN JOAQUIN Date: 6-, IL <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 05bQ914' <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: t- ,_ sc- JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: k c_ E (` APN f FEE DUE: <br /> Area Code -Telephone Number: d 3 3—3 C, EXP.DATE: DRIVEWAYS: <br /> 19 STREET: T RAZA <br /> SITE INFORMATION: AREA: 7r9AV1_y QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: S C,-S -'r Q FORMS: <br /> City,State,Zip Code: -7 2 6-4pu NOTES: <br /> Area Code -Telephone Number: U 93-3 - PO PI <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: —+O—FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <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 H' way Right-of-Way on the <br /> side of Q (�- ncc <br /> weisr J approximately rte �i <br /> of A kflJE. �f ,by installing 'Z>L&> <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+ORM9&TEMPtATESENCROACKMENT PERMIT DRIVEWAY.do 10MI <br />