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COUNTY OF SAN JOAQUIN Dater_i <br /> DEPARTMENT OF PUBLIC WORKS �— <br /> 1 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> 2i C 2 poi✓ FA <br /> #11005 ISSUE DATE <br /> Name _ �_- 370 -�_ FEE DUES S�O /Z !'v S V .DATE DRIVEWAYS: <br /> Address EET G6 • <br /> City,State-Zip Code TYPE V <br /> 6/ 1 39 <br /> ORMS S - <br /> (Area Code)Telephone OTE <br /> SITE INFORMATIO <br /> Parcel Owwfs Name <br /> Site Address DRIVEWAY <br /> S LOn� S -3 TYPE QUANTITY_ WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> 1?1 D � 8 S COMA�RCIAL <br /> (Ana Code)Telephone USTRIAL R/W <br /> IDENCE <br /> _ CONTRACTOR PAVED FRONTAGE <br /> CONST- GTA: Ft. X WIDTH: Ft. <br /> Name <br /> Address The gacd hereby applies for permission to encroach on <br /> Coemty Highway <br /> Right-of-Way on the v side of <br /> City,State-Zip Code approximately !mile CWE. r of }MASE U� <br /> Q-p. ,by installing <br /> (Ana 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 /> Aco=\Per App1FamWdvewayEaved&mtage <br /> �C.J <br />