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COUNTY OF SAN JOAQUIN <br /> ' R ecraved by_e� <br /> DEPARTMENT OF PUBLIC WORKS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> ..r <br /> APPLICANT OFFICE USE ONI,'( <br /> JOB#11005 ISSL 's DATE <br /> FEE:DUE_ 1 k G <br /> / Z c tDATE i I o DRIVEWAYS: <br /> S: <br /> � STREET I i`>r= AK— �'�� a <br /> ® Loci E 0 2D QUAD <br /> TYPE P V�,_) <br /> FORMS- <br /> Telephone OTE <br /> EF INFORMATION S L <br /> Parcel Owner's Name <br /> (� <br /> Siw <br /> 'WAY <br /> 0z s ' IDTHSv? fT� <br /> L E QUANTITY <br /> Ci ,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Arca Code)Telephone HNDUSTRLAL @ R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTIi 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 side of L ®'NK- r-JU 14- <br /> City,State-Zip Code by <br /> I g Q feet °✓ST of_1-t Vz <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 /> AccessWer App\FormlDrivewayfaved fia tag e <br /> C'�J <br />