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COUNTY OF SAN JOAQUIN mate: '=_17-3/O b <br /> Ll <br /> DEPARTMENT OF PUBLIC WORKS a; y <br /> .DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ON] Y <br /> c "a JOB#11005 ISS"CE,DAE <br /> Name APN 1*1 - Zti o - -N1 FEE DUE —— <br /> `I EXRDATE DRIVEWY YS: <br /> Address STREET M o o R• 1 E C_• AVE ; <br /> AREA— TOc.1e-Tort QUAD_.LJ7;7� '_ <br /> /y City,State-Zip Code TYPE V E R «_ <br /> FORMS_ SQ yJ 0 —1 _ <br /> (Area Code)Telephone NOTE <br /> O P/pt <br /> SITE INFORMATION <br /> Parco Owner's 149me <br /> Site Address <br /> KDRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> AGRICULTURE 1.i�FRONTAGE <br /> (Area Code)Telephone COMMERCL4L <br /> VNDUSTRIAL @ RPV <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE i <br /> LENGTIE 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 —C"Ar side of <br /> City,State-Zip Code apprwdznately /ro (Lsp mile _of- GA 0 <br /> Avg• •by installing <br /> (Anes Code)Telephone <br /> Work <br /> will eomnmwe 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 /> AooewTcr AppTorm\1kivewayRaved fiodAge <br />