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COUNTY OF SAN JOAQUIN Date: Ll/q <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: �- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 039��9 <br /> APPLICANT OFFICE USE ONLY <br /> Name: c•t d N ct I <br /> Address: Oa E e 7 JOB#: 11005 ISSUE DATE: <br /> d <br /> City,State,Zip Code: p 4-e b Ci' r a APN r FEE DUE: <br /> Area Code -Telephone Number: EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: c a Y TYPE: <br /> Site Address:IL-5 Hi kkal-(1 Ck V : FORMS: <br /> Cit ,State,Zip Code: c K4c tti NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State; Zip Code: INDUSTRIAL: @ RIVV <br /> Area Code -Telephone Number: RESIDENCE: =jZ5eL <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 Hi hway Wa Right-of- on the <br /> side of A/E approximately ile <br /> of ti, GA029P �i, ST G1<7-&A1 ,by installing �W <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH (Separate sheet may be submitted) <br /> I <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:!CENTRALSERVICES!CLERICAL`:PUB-SV'NK,MASTER.PSIENCROACHMENT PERMIT DRIVEWAY DOC (10,09) Page 1 of 2 <br />