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COUNTY OF SAN JOAQUIN Date:_ p <br /> . N T <br /> DEPARTMENT OF PUBLIC WORKS Receiwcby`- <br /> CR# , <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> N e APN 20 - 1 Ll0 - O ! FEE DUE <br /> 7- _ R d <br /> —d ,— DATE DRIVEWAYS: <br /> Address rFOR <br /> T_ <br /> �,o p i✓, c'.�t 9 G1� = V%l (.2. QUAD 5 <br /> City,State-Zip Code lief <br /> 7 , s <br /> (Area Code)Telephone NOTE <br /> ^ srm INFO TION <br /> Parcel Ov=fs Name �r <br /> Site Address DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL _ @ R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the AlO�'T side of (,(J16bll 7ont7 ;Elz <br /> City,State-Zip Code approximately feetmile 10657 of X-111XI-Oh I <br /> eowp ,by installing_MU 2 <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _ NO YES Contractor's License <br /> Acoe Tcr App\F—\Driv—yPaved&outage <br /> /U <br />