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COUNTY OF SAN JOAQUIN Date: _i�_'/ <br /> DEPARTMENT OF PUBLIC WORKS Recacived by L7W_ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> U Nr(t-2- JOB# 11005ISSUE DATE <br /> Name APN/'// ^- Z 7� -0 FEE DUE_ �a <br /> .DATE DRIVEWAYS: <br /> Address STREET g ar G✓ ' <br /> G� 01 X'7'0'5 AREA Z QUAD E� <br /> City,State-Zip Code TYPE D <br /> FORMS e-17 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcels Namg <br /> w� <br /> Site Addre ZD DRIVEWAY <br /> C TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE (3a FRONTAGE <br /> 7— COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> r�@3AA&2 rT„�-� GTH Ft. X WIDTH:- Ft <br /> Name <br /> CIO <br /> Address 2 The undersigned hereby allies far permission to enero h on County Hi way <br /> Right-of-Way on they N side of q✓a� <br /> City,State-Zip Code approximately l da/mile Lam.�J;S"T of <br /> _ <I <br /> by installing L <br /> (Area de)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 /> AooesslPer AppTormOrivewayPaved fraotage <br />