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COUNTY OF SAN JOAQUIN 7'a`e: o_i a /d,t, <br /> DEPARTMENT OF PUBLIC WORKS :2et;eivoi by-5e,:R# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE 1 / <br /> API`l�_- j Do -1_ FEE 2DUE <br /> ylei�r D .DATE DRIVEWAYS: <br /> Address STREET ' <br /> eleerl - I AREA�._ to QUAD <br /> Citv State-Zi Code TYPE PW <br /> o GL X33 vFORMS <br /> (Area Code)Telephone NOTE TT'' <br /> 0 3 - Ivo PiP� <br /> SITE INFORMATION <br /> Parcel Own A Name ' <br /> Site Address DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> AGRICULTURE @FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> VNDUSTRIAL (a3 R/W <br /> IDENCfi <br /> CONTRACTOR PAVED FRONTAGE <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 A aM_side of z',6A4JVV 9b. <br /> City,State-Zip Code approximately /mile 3T of.5EIDA2,64 <br /> -Adle—. .by' <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 /> Aooess\Per App\FamXDdvewaylaved fixeage <br /> r <br />