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COUNTY OF SAN JOAQUIN DRrreived byf"':_if ice' i <br /> -C� <br /> DEPARTMENT OF:PUBLIC WORKS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> AppI�ff OFFICE USE ONL1' <br /> 6(/, JOB#11005 ISSUL DATE ! / <br /> � 6 Name APN�- - FEE DUE <br /> I /f o. (3 o X -e)-7 .DATE DRrrw'EWA;S: <br /> Aa�ss r STREET TM- <br /> /►1, AC t6ouaA2a R��_ <br /> 'V �i�'a�a c.A 79 5 QUA56,2— <br /> Gity,S e- ip Code TYPE —�rJ <br /> t _ <br /> 1 / 3FORMS iJ5 wto R-17 <br /> (Area Code)Telephone NOTE 41 iZX <br /> S INFO TION <br /> Parcel s N e <br /> Site AsDRIVEWAY <br /> C %S TYPE QUANTITY WIDTHS <br /> Qlity,Stat dip Cale AGRICULTURE Q <br /> FRONTAGE` <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ 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 thedlt, side of <br /> City,State-Zip Cale approximately- 164:�ff of <br /> 7M, ,by installing 7)tom. <br /> (Area Code)Telephone <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 /> AccessTer ApplF—Ori—aypaved&natal <br />