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COUNTY OF SAN JOAQUIN Date: P I 1049 <br /> F DEPARTMENT OF PUBLIC WORKS Receive I by_ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> Ap OFFICE USE ONLY <br /> // ®S mac' JOB# 1005 ISSUE DATE <br /> N e �© if APN - �SD - 0�3 FEE DUE* _ <br /> _ Lq <br /> �jEXP.DATE DRIVEWAYS: <br /> Ad&4 STREET -$y r AJ RM• *_ <br /> ef-etd QUAD �,Z <br /> ity, tate-Zip Code TYPE *_ <br /> FORMS 5S9-17 <br /> (Area Code)Tel ep � OTE <br /> � 2 o SITE MIZ-Aon 2 <br /> Parcel Owner's tame <br /> /S"Q <br /> Site Address <br /> DRIVEWAY <br /> City,State-Ap Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> ea Code)Telephone COMMERCIAL <br /> (� INDUSTRIAL @ R/W <br /> 2a� •-'- 0 �� ��� <br /> fESIDENCE 1.-, <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH. Ft. X WIDTH:- <br /> Name <br /> IDTH:Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the SG1sTH side of BY&O-) JeD. <br /> City,State-Zip Code approximately 2100 int A'w£5T of f�� <br /> 7�DAD ,by installwg 77 W <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 /> AceessTer AW\Form\DrivewayPaved f atage <br />