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COUNTY OF SAN JOAQUIN Date:OZ /6 f& 10(.o <br /> DEPARTMENT OF PUBLIC WORKS Received b _ <br /> � `� <br /> DRIVEWAY AND PAVED FRONTAGES cR# 7 118 <br /> PERMIT APPLICATION <br /> jj APPLICANT OFFICE USE ONLY <br /> d Jl� <br /> Vi C P r,!5e__E JOB#11005 ISSUE DATE <br /> Name APN a6Z-ago__31 FEE DUE�2?S <br /> DATE DRIVEWAYS: <br /> (� ddress STREET tmRzi ms RD <br /> Ul i r/f j s� CSA LoYU QUAD <br /> C <br /> State-Zip Code TYPE to <br /> FORMS 5 WW - /7 <br /> (Area Code)Telephone NOTE <br /> O <br /> SITE TIO <br /> r t �6c<' <br /> 'l Parcel Ovv�ei's Name ' <br /> [E�aP liP Ce-., -' , DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/VfT <br /> IDENCE X 2 ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on Comity Highway <br /> Right-of-Way on the SotrrN side of �t5 F.D <br /> City,State-Zip Code approximately-r 5W 47CUFMik UD SC- of VjCMr>0_y <br /> OEM .by' :;Pl J <br /> (Area Code)Telephone <br /> will commence on or about for approximately days. Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _ NO YES Contractor's License <br /> AooasslPer i%T\Fo=\Wv—ayPaved&nntage <br />