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COUNTY OF SAN JOAQUIN Date: / oIC <br /> DEPARTMENT OF PUBLIC WORKS Received by Qq�_ <br /> DRIVEWAY AND PAVED FRONTAGES CR# 4 " <br /> PERMIT APPLICATION <br /> APTLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE I <br /> Name APN O3 - - FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> Addres STREET E. <br /> AREA <br /> QUAD <br /> X IitY,S e LZT TYPE ZY.J s <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMAIT <br /> n, H <br /> Parcel Owners Name <br /> Site Address 3 <br /> C(. \ +� C� 4 53 DRIVEWAY <br /> Cit! State-7�i Code TYPE QUANTITY WIDTHS <br /> 3 _ � GRICULTURE Q FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH <br /> Name Ft. X WIDTH: Ft. <br /> Address The undersigned Hereby applies for permission to encroach on County Ifighway <br /> Right-of-Way on the o side of -1,0A-16 ?,Q6E ,eD <br /> City,State-Zip Code approximately �Qp /mile of TACK-7V <br /> RoRD. ,by installing DG✓ <br /> (Area Code)Telephone <br /> will commence on or about Work <br /> for approximately days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _ NO YES Contractor's License <br /> Aceew\per AppTormXDriv_yPaved fiantage <br /> l% <br />