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i <br /> i <br /> COUNTY OF SAN,JOAQUIN Date " " 'q <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS M PAVED MONTAGES <br /> PERWIT APPLICA11710N CR#: c'-'>.3` 7 e5-c�t7SS' <br /> APPLICANT OFF10E!USE ONLY <br /> Name: e 4�• r� <br /> Address: I 2�&o JOB# 11005 ISSUE DATE: <br /> City,State,Zip Code: (i1 C+ APN c� t FEE DUE: <br /> Area Code -Telephone . EXP.BATE: DF#V IAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: <br /> Parcel Owners Name: r, TYPE: , <br /> Site Address: L FORMS: ` <br /> City,State,Zip Code: N NOTES: <br /> Area Code -Telephone rnber: /r (O <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUAN71TY WIDTHS <br /> Name: A AGRIUTURE: j OFRONTAGE <br /> Address: bEHf .: <br /> Ci State,Zi Code: v. INKS t�'R/W <br /> Area Code -Telephone Number: RESfNCE <br /> RAS i=RTACE <br /> LENGTH' Ft X w1m.. <br /> Ft. <br /> The Rdoijigned herebyfor permission to excavate,construct ardor otherwise encr �ch on y F arc the <br /> side of } '2 2_ coapproximately ILU1 <br /> Of r'tk-t M'Lk se XZ)0 ,by ii targ <br /> Work will <br /> commence on or about for approximately clays. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _ YES NO Contraetor"s License` <br /> Y TORMS 8 TEMPIATMENCROACHMENT PERWT MvEwwdoc am) <br />