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COUNTY OF SAN JOAQUIN mate: r r r.�o <br /> 4 � DEPARTMENT OF PUBLIC WORKS Rec by- Z-- <br /> 51 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name APN 0 - FEE DUE_ g0 <br /> p U . EXP.DATE DRIVEWAYS: <br /> Address STREET T/PT!! S7. ' <br /> O. ,Y 9 579 a QUAD + <br /> City,State-Zip Cock TYPE • <br /> �r9c,eflME a <br /> c FORMS 7n-Qu0m_) X-717 <br /> (Area Code)Telephone NOTE —'— <br /> SITE INFORMATION <br /> Parcel Owners Name <br /> Site Address <br /> Za2Co F. .ST DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> N zO AGRICULTURE @ FRONTAGE <br /> (Ates Code)Telephone COMMERCIAL <br /> INDUSTRIAL _ (a3 R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIL- Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for paimission to encroach on County Highway <br /> Right-of-Way on the -Urn U=�.�,�side of 'I,e7H � <br /> City,State-Zip Code aPP ely /Gt7 CFe maC .S'..,q�, of ar•• <br /> -5rrR'Zer .by installing Do- <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 /> AfloesalPer ApplForrnlDrivewayEavad&oota®e <br />