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COUNTY OF SAN JOAQUIN Date: /C-/ Z /Q`.3. <br /> DEPARTMENT OF PUBLIC WORKS d by <br /> CR# j <br /> v <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> ApPUCANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> N '� o � 'N _1_ FEE DUE Vern <br /> A/I U13dL— EXP.DATE DRIVEWAYS: <br /> Mdresi STREET <br /> tAREA E5CALOrt/ QUAD Ste_ <br /> ty tate ip TYPE vE <br /> &�S-�(Area <br /> ORMS � L� e/7 <br /> Codelephoae OTE <br /> /Z <br /> SITE INFORMATION <br /> Parcel Owner's Name ' <br /> iSrte Address f DRIVEWAY <br /> IF TYPE QUANTITY. WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> NDUSTRIAL@ R/W <br /> SIDENCE �— <br /> (� 7 3 L r <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 fAn9 side of 5FMAAFe-n G <br /> City,State-Zip Code approximately feet/mile A,2tog -Al of 11WY/2U <br /> by installing 1:;140 <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 /> AccessTer AppTormOrivewayPaved fzodage <br />