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COUNTY OF SAN JOAQUIN Date: 1)' l l "/C-"5 <br /> DEPARTMENT OF PUBLIC WORKS Received by- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE, <br /> sine APN 1 S - I 2D - FEE DUE f <br /> L 7-1 zfJ - 'Y EXP.DATE DRIVEWAYS: <br /> Address STREET_,ELL/A Arg, <br /> STo G*iiA-/ FT 2-07 AREA -5!rbr.Cnml QUAD /1! <br /> City, tate-Zip Code TYPE k <br /> FORMS SS k^1 W , 7- --1`7 <br /> (Are Code)Telephone NOTE <br /> SITE INFORMA�gON <br /> Parcel Owner's Name ' <br /> Site Address <br /> it-Z)c-f" Ca¢ DRIVEWAY <br /> Cify,State-Zip Code TYPE QUANTITY WIDTHS <br /> Y72, AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> VND <br /> USTRIAL Q R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> A.— e, LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address IThe undersigned hereby applies for permission to encroach on County Highway <br /> -C Right-of-Way on the side of <br /> C'ty,State-Zip Code approximately feet/mile of <br /> o t.ta-- •by installing <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 /> Aooess\Pea AppTorniMrivewayPaved f a tage <br />