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- P5-©9611,33 <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: O.' 4i?7 <br /> APPLICANT OFFICE USE ONLY <br /> Name: T G A <br /> Address: ( t 7-n ; JOB#: 11005ISSUE DATE: <br /> City,State,Zip Code:a�coC_x Tom G A . APN l7�'!S j�o FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: &kT" <br /> SITE INFORMATION: AREA: GAJ QUAD <br /> Parcel Owner's Name: t:5�,a. r, TYPE: <br /> Site Address: FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: �'cu - ,U, AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: INDUSTRIAL: RMI <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby ap'E3-r- 1-1 <br /> li s for permission to excavate,construct and/or otherwise encroach on County Hi y Right on the <br /> 'So v i H side of E3-r- W S approximately ZOO <br /> ofby installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this protect be self-installed? YES NO Contractors License <br /> Y`,FORMS d TEMPLATES ENCROACHMENT PERMIT DRIVEWAY d�1o5.'o8) <br />