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COUNTY OF SAN JOAQUIN Date: 1. / IZ/ 6 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 15V-33 61 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLIC OFFICE USE ONLY <br /> C� JOB#11005 ISSUE DATE / <br /> t Name APN.1-1 - 1 - 42. FEE DUEo- <br /> ( IEXP.DATE DRIVEWAYS: <br /> R STREET E 1.-E V E N T H �IzEE T <br /> ,YQ STo c- TON QUA 5& `� <br /> tale-Zip Code TYPE rD Ra V E�!Ay <br /> FORMS <br /> (Area Code)Tel OTE <br /> S INFO N <br /> 1 i 1 <br /> � ite /a <br /> Address DRIVEWAY <br /> (` TYPE. QUANTITY WIDTHS <br /> i State-Zip Code GRICULTURE (a3 FRONTAGE <br /> • �� <br /> (Area Code)Telephone COMMERCIALUSTRIAL R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTTI Ft. X WIDTH Ft <br /> Name <br /> Address The undersigned hereby applies far permission to encroach on County Highway <br /> Right-ofe on the 1J o2't'H sideof S'T <br /> ro�cimately_ S"-7 D feet/ 1�1 E S'T of "B <br /> City,Stale-Zip Code 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 /> Acemwer Am\Fo m\DrivewayEaved&atta®e <br />