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/i , 14, r is <br /> COUNTY OF SAN JOAQUIN n3�: <br /> E c("ved by - <br /> DEPARTMENT OF PUBLIC WORKS _:0 n',�7 '321 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLiCANT OFFICE USE ONL�i' <br /> YI�r�ifl fl JOB#11005 IS SUE DATE <br /> Name APN lam_- 25j_ FEE DUE <br /> _ v o <br /> ` DATE DR1jTEWAYS: <br /> � <br /> Add <br /> res r STREET ' QUAD AS— <br /> K <br /> City,State-Zip Code TYPE <br /> ORMS �,Area Code)Telephone OTE <br /> [���SrrTE�INFO�ONNti <br /> parcel Owner's Name <br /> Site Address DRIVEWAY <br /> 1 �, / - TYPE QUANTITY. <br /> WIDTHS <br /> ,.( City,State+Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Area Co(e)Te cphone NDUSTRIAL@° RIW <br /> E <br /> SIDENC —�— <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on Counji-of way <br /> Right-of-Way on the A4'1" side of H 1.4 W.LEY <br /> approximately Zoo deo /mile 5a A 2:jW of <br /> City,State-Zip Code ,by installing QW <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 /> Acoesmer App7ormlDriveway.Paved frontage <br />