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COUNTY OF SAN JOAQUIN <br /> :2e eiasd by '5-' <br /> DEPARTMENT OF PUBLIC WORKS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION _ <br /> APPLIC OFFICE USE ONLY <br /> JOB#11005 ISSLTI'DATE <br /> Name APN& -��- /7 FEE DUE 9k6 <br /> j 22 4 vlDATE DRI�TEWAYS: <br /> ss ' STREET Tr-- # <br /> `1 �z � GoD/ QUAD /tiE__ <br /> State-Zip e TYPE Cod --- <br /> City, FORMS 55 <br /> Ald <br /> A O OTE <br /> (Area Code)Telephone — <br /> SITFA <br /> FORMATIgJU r r� <br /> e0 r r'- ctr�t <br /> P 1 s Nam <br /> n 7 (v e cL f t _ <br /> to A eas _ Z v DRIIVEWAY <br /> 40J : �YTYPE QUANTITY WIDTHS <br /> \ Ci Zi AGRICULTURE <br /> (a�FRONTAQE <br /> (�v J r✓ l� <br /> (Area Code)Telephone ��COMMERCIAL@R/W <br /> PNDUSrME110E ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> (STH: Ft. X WIDTH:__ Ft. <br /> Name <br /> Address T�undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of P_AGTX.& <br /> City,State-Zip Code approximately 30 feet/mile 4A)fCT of AbFJw_ <br /> by installing Dln2 <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 /> Aooess\Per ApplForm\Driv yPaved&notage <br />