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COUNT^ �T OF SAN JOAQU <br /> SH <br /> DEPARTMENT OF PUBLIC WORKS R,.'�eived by <br /> DRIVEWAY AND PAVED 17RONTAGES <br /> y'Z �yy�� PERMIT APPLICATION <br /> P ANT OFFICE USE ONLY!' <br /> 'ff',`lv 0 JOB#11005 ISSUE DATE ( <br /> _ Name APN I1 I - X3 i - FEE DUE <br /> �s r DATE !/2 0/o - DRIVEWAYS: <br /> Address STREET <br /> r;�. y c N —QUA 5 <br /> _17G/" State-Zi Code --- 5 <br /> City,. <br /> j (s, d 5 l '�� /� ORMS <br /> (Area Code Tlephond TE <br /> tv- <br /> ITE INFORMATION <br /> Parcel s Name <br /> j <br /> Site Address DRIVEWAY <br /> S um �� 95 <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> O AGRICULTURE Q FRONTAGE <br /> (Arca Code Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> --- Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the— Ar'`{ side of 0411*T ST. 11 <br /> City,State-Zip Code approximately ' feel/mile zjic _of 11.v S- <br /> 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 /> Aoo=kPer App\Fam\DdvewayEaved frontage; <br />