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COUNTY OF SAN JOAQUIN Date: / <br /> DEPARTMENT OF PUBLIC WORKS Receiv,,d by <br /> CR#_ -1- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUEDIIE <br /> Nam APN�- 30 <br /> - 1 FEE DUE <br /> f �-- EXP.DATE,,... A DRIVEWAYS: <br /> Address STREET <br /> ell <br /> 7 0'7AREAS IaG,�?"off f QUAD V/f/ *_ <br /> City,State-Zip Code TYPE aW *_ <br /> FORMS � /7 <br /> Arca Code)Telephone NOTE <br /> 0 <br /> SITE INFORMATIW <br /> �2l M <br /> r20� <br /> Parcel Owner's Name —T <br /> Site Address DRIVEWAY <br /> �(Am. <br /> THS <br /> CityState-Zip Code TYPE QU T FRo�AGRICULTURE Q <br /> Code)Telephone COMMERCIAL <br /> USTRIAL Q RAV <br /> SIDENCE <br /> CONTRA OR PAVED FRONTAGE <br /> /",( C. LENGTH: Ft. X WIDTH: Ft. <br /> nn Name <br /> A, wCNcf {7n /f, �f� ;� <br /> —�-� The undersigned hereby applies for permission to encroach on Couny Highway <br /> Address �}]_�� Right-of-Way on the �sT side of G oGDEn/ ,9TW Af. <br /> City,State-Zip Code approximately ZOO of <br /> mileJTff <br /> Z �/f`/ ,by installing <br /> ( ea 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 /> AecessTer App\Form\DrivewayPaved&nntage <br />