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� via/eft a <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> r,*1 Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: ©99509 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> State,Zi Code: APN f+t - Q - FEE DUE: <br /> Area Code -Telephone Number: �Pp EXP.DATE: 7-t— Zolo DRIVEWAYS: <br /> STREET: ,t <br /> SITE INFORMATION: AREA: R/ QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: EgAW� 1,11 ZS <br /> FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Tele hone Number: <br /> DRIVEWAY <br /> CONTRA TOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE.: I @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RM <br /> Area Code -Tele hone Number: ,p f 7 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby a plies for permission to excavate,c eruct and/or otherwise encroe-jrh on County H' way Right-of-Way on the <br /> side of approximately fee ilei <br /> of C by in talon G t7a <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> __._---- <br /> i <br /> rN <br /> 1 � <br /> Will this project be self-installed? YES NO Contractor's License <br /> V 1FORM9 A TFMQI ATP—'FNCROACHMFNT RFRMIT DRIVFWAY da MM <br />