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COUNTY OF SAN JOAQUINxi <br /> DEPARTMENT OF PUBLIC WORKS -�envj;3 by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION _ <br /> APPLICANT OFFICE USE ONL,1z <br /> JOB#11005 ISSIF i DATE <br /> LT-...._ w F� , APN J 1 q - 0.5-0 ---0-7/00 FETE DUE <br /> L 1 U/O EXP.DATE DRrsrEW.AYS: <br /> AddressSTREET "F ST -- ` <br /> S-res e�.�/ QUAD�?-- # <br /> ,State-Zip Code TYPE -PA.) <br /> ----- <br /> C�. / C o Itis S gFORMS <br /> � <br /> (Area Code)Telephone NOTE <br /> SrM INFORMATION <br /> Parcel Ownets Name ' <br /> iL <br /> O Site Address <br /> DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code: AGRICULTURE @ FRONTAGE <br /> S r'Tz°C Ktow' — C - -7`>—_t:9 COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL@ R/W <br /> �o I — L j —9-S75RESIDE NCE —�— <br /> CONTRACTOR PAVED FRONTAGE <br /> _ LENGT11 Ft. X WIDTH:_, Ft. <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Highway <br /> Address ' -Right-of-Way on the QRST side of -TrX-f7 <br /> City,State-Zip Code: approximately . e of wascm) tXvy <br /> by' <br /> (Area Code)Telephone <br /> Work <br /> vvill 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 /> AoassTer App\FoamOrivewayFaved frooiage <br />