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COUNTY OF SAN JOAQUIN Da#e: aLU ♦q <br /> DEPARTMENT OF PULIC WORKS -----`— <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERANT APPLICATION CR#:_ O 3'4/3 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: aAPN 21z--Ae:. FEE DUE: <br /> Area Code -Telephone umber: EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 1a FORMS: <br /> City, State,Zip Code. a NOTES: <br /> Area Code Tele hone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: 0-RONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zi Code: INDUSTRIAL: RJW <br /> Area Code -Telephone Number: ARESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Com <br /> .t/mr_rw side of e-z--wez R D tY H' y Right-of-Way on the <br /> of eo444le approximately /SO frAST <br /> by installing <br /> commence on or about Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this proiect be self-instal!ed? YES NO Contractor's License <br /> Y�FC,RMS L T=Mptf TES ENCRDACNIAENT PERMIT DRWEWV dtl 10&'081 <br />