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COUNTY OF SAN JOAQTTT-N Late: , < <– Ae <br /> Received."ly � <br /> DEPARTMENT OF PUBLIC WORKS CRN C�1< > <br /> DRIVEWAY AND PAVED]MONTAGES <br /> PERMIT APPLICATION <br /> APPIJ OFFICE USE ONLY <br /> JOB#11005 ISSUE DAT <br /> N APN�- D _ 3� FEE DUE , l� <br /> DATE DRIVEWAYS: <br /> ` STREET �nJ"7l-,,z Z A� <br /> ss �5 <br /> QUAD <br /> State- Code TYPE ZWJ <br /> -C OTE S—T LvW} <br /> (Area Code)Telephone I2 T'I PE <br /> SITE INFORMATION <br /> Parcel pors Nam �. <br /> Site Ads DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone . COMMERCIAL <br /> USTRL4L, @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTILFt. X WIDTH: Ft <br /> Name <br /> Address The tmdersigne .herby appEes for permission to encroach on CounV Highway <br /> Right-of-Way on the E5J" side of t�azr <br /> approximately le mile of <br /> City,State-Zip Code .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 /> Acoeaffer App\Form\DrivewayPaved fie taip <br />