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COUNTYOF SAN JOAQUIN <br /> :Irceivcdby —)G.- <br /> DEPARTMENT OF PUBLIC WORKS 1-110 G � <br /> DRIVEWAY AND PAVED MONTAGES <br /> PERMIT APPLICATION <br /> APPDCANT OFFICE USE ONL)' <br /> JOB#11005 ISSUE DATE <br /> N APN t-71 - a 7o - 6o FEE DUE � <br /> !ar' EXP.DATE DI::�'EWAYS: <br /> Address STREET ZE/� s7. s <br /> P O: B6X '55-85- �r�'.�/ QUAD. _ + <br /> City,State-Zip Com TYPE _-- <br /> r4c Aar C!9 FORMS <br /> (Area Code)Telephone NOTE <br /> -- <br /> SITE INFORMATION <br /> Parcel OwnePs Name <br /> Site Address RIVEWAY <br /> O /STN <br /> City,State-Zip Code TYPE QUANTITY. WIDTIB <br /> S?�ckTa�U Z6CACIRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAOI3 <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 nvanY side of 40" x,,,^q/ $7. <br /> City,State-Zip Cade approximately !�i3ti9��of 8 <br /> �'rgsFr. •by instal ng <br /> (Area Code)Telephone <br /> Work <br /> vvill 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 /> Aooew\Per nppTormlDrivewayPavea frontage <br />