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i" COUNTY OF SAN JOAQUIN Dater_/ }/ 0 <br /> DEPARTMENT OF PUBLIC WORKS Received by -fW-- <br /> cR# t? )g d <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Ne APN 249 --,15'0 - 09 FEE DUE_ PTIjOO <br /> DATE DRIVEWAYS: <br /> Address- STREET t S�, STREE� R/�Rtr�i9 QUAD SW # <br /> tAREA <br /> City,State ip Code TYPE <br /> ry�� �y=�rSl ORMS S54-17 <br /> (Aref�Telephone NOTE <br /> SITE INFO TION <br /> Parcel Owncie ane ' <br /> ' ss <br /> Sddre <br /> DRIVEWAY <br /> 'City,State-Zip Code TYPE QUANTITY WIDTHS <br /> _ AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> IRE 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 the side of <SSR t+ 2T 4-All <br /> City,State-Zip Code approximately � /iV0,t-7 of A'ErEE <br /> ri <br /> .by installing -0tZ <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 /> AccessVer App\Form\Drivewayfaved frontage <br />