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COUNT',`-OF SAN JOAQUIN <br /> •: - :ke-cm teed <br /> DEPAR'T'MENT OF PUBLIC WORKS CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPDCANTQ OFFICE USE ONLY <br /> duh i e G� JOB#11005 ISSUE ISA <br /> Nf�-�_fL FEE DUE� <br /> K n <br /> EXP.DATE DRIVE'NAYS: <br /> * <br /> 7kt 'p <br /> S�o.Z STREETC !37711/ QUAD �I/E _ <br /> Ci ' StCode TYPE _ <br /> ORMS <br /> (Area Code)Telephone OTE —� _T <br /> S INFO TION <br /> P 1 N <br /> y � <br /> Site Address S—a oZ <br /> Ca <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY_ WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Arca Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> rSIDMICE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENOTI1 Ft. X WIDTH: It <br /> Name <br /> Address The undersigned hereby applies for pmmission to encroach on County Ifighway <br /> Right-of-Way on the_ -s' side of D&!:077 A) AP <br /> City,State-Zip Code aPproximately ew,:�,v mile "Ove 7,0/ of ,4 <br /> by installing <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 /> Acc—Ter App\FormlDdv-"yEaved f atalp <br /> 5 <br />