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I <br /> - COUNTY OF SAN JOAQUIN Date: /-2_/_Ck <br /> DEPARTMENT OF PUBLIC WORKS CRv�by L <br /> i <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> i <br /> n �n 7 LIC OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE / / <br /> NZtL - <br /> [k DATE .�-� FEE DUE <br /> DRIVEWAYS: <br /> Add,?, STREET G <br /> - AR <br /> QUAD <br /> TYP <br /> Z' E <br /> (Area Code)Telephone OTE S <br /> S1T� ft Op A&` <br /> 1 v�. <br /> RIVEWAY <br /> ty State-Zip Code TYPE QUANTPI'Y. WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> Area Code)Telephone COMMERCIAL <br /> USTRIAL <br /> IDENCE <br /> CONTRACTOR VID FRONTAGE <br /> GIH <br /> Name Ft. Ft. <br /> _. <br /> Address The undersi u*d hereby applies for permission to encroach on County Kighway <br /> Right-of-Way on the side of 6�) , L �+►•� �QD <br /> City,State-Zip Code approximately mile So&ry of <br /> —� by instaffiigDLc7TNi9,J3� <br /> (Area Code)Telephone <br /> ------------- <br /> will commence on or about Work <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? —NO YES Contractor's License <br /> Acc=kPer AppWotmlDdvewayPaved frontage <br /> A <br /> 7 <br />