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COUNTY OF SAN JOAQUIN Der: <br /> DEPARTMENT OF PUBLIC WORKS Re(seive,�by_SH <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PUCANT OFFICE USE ONLY <br /> 0 JOB# 11005 ISSUE.DATE <br /> Name APN x,63 - 0$10_ 2a1 FEE DUE� I 10 <br /> .DATE DRIVEWAYS: <br /> !� Address STREET }AP, E l A►-J E <br /> 7� CA AREA_ <br /> L D I QUAD tJ r_. <br /> City,State-Zip G6de TYPE "D 9-1'V E W fA'�l <br /> Sa)- FORMS 'iZ—11 SS l�7 <br /> (Area Code)Telephone NOTE <br /> -3La <br /> SITE OR1iTIS <br /> POwnefs�Name ' <br /> - 2 Site AddressoC <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> ^� USTRIAL @ R/W <br /> J3 I7 RESIDENCE <br /> CONTRACTO pp PAVED FRONTAGE <br /> S ha, cn LENGTH: Ft. X WIDTH: it. <br /> Name -7 <br /> Address The undersigned hereby applies for permission to encr hon Cot ty Highway <br /> L(� Q Right-of-Way on the side of z1z6_z ,4A/I'6 <br /> City,State- Code approximately Agn-51 fe mile SR 67' of LQ 5_r <br /> ZEFF 4P. ,by inst <br /> (Area Code)Telephone <br /> 333 � s <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> J <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aooeas\Per AM\Form\DrivmayPaved finntage <br />