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Lme: f rJW I (/' <br /> COUNTY OF SAN JOAQUIN Received by .- <br /> DEPARTMENT OF PUBLIC WORDS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNIlT APPLICATION _ <br /> OFFICE USE ONLY <br /> APPLICANT ISSUE DATE <br /> JOB#11005 2 FEE DUE -/ �o <br /> ame N�D�ATE d.�o r. DRIVEWAYS: <br /> STREET -4 �r14A,�f GJA� <br /> ss y►'I,g.�1'IFcA QUAD$f_____ <br /> t � TYP ' <br /> Cityc-zip Code EORMS <br /> 1 (Area Code) cl hone OTE <br /> LA <br /> SITE INFORMATION <br /> parce[ s Na= <br /> Site s DRIVEWAY <br /> • QUANTITY WIDTHS <br /> TYPE <br /> City,State-Zi ot AGRICULTURE FRONTAQE <br /> COMMERCIAL ----- <br /> (,Area Codd Telephone US <br /> CONTRACTOR PAVED TRIAL <br /> IDENCE <br /> FRONTAGE <br /> QTTi Ft. X WIDTH Ft <br /> Nsme Fcion to encroach on County Highway <br /> The undersigmd,hereby applies far permis <br /> Address Right-of-Way on the tAs7 side of ;� 7 CJRY <br /> feet/mile Almayh of O 'ylS�1✓ <br /> City,State-zip Code <br /> approximately ,by installing DG? <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AccemTer ApplFormUkivewaYPavad frottage <br /> �5 <br />