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COUNTY OF SAN JOAQUIN <br /> Received by_ L <br /> DEPARTMENT OF PUBLIC WORKS CR# Dq8 B 40 <br /> - DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLIC OFFICE USE ONLY <br /> J <br /> 6'.., <br /> #11005 ISSUE DATEFEEDUEZDATE DRIVEWAYS: <br /> 's ET <br /> oc C Z/a sro�kcoN —QUAD Kf s <br /> City,State-Zip Code TYPE 'U lJ <br /> ORMS 55 <br /> 20 A/d p► <br /> (Area Code)Telephone OTE <br /> SITE INFORI UTION <br /> Parcel Owners N <br /> ` Addrea� S./ DRIVEWAY <br /> ore 'tt TYPE QUANTITY- WIDTHS <br /> State-Zip Code AGRICULTURE @ FRONTAQfi <br /> . � � f ^ COMMERCIAL <br /> (Area Code Telephone �R/ViT USTRIAL _ <br /> IDfiNcfi . • <br /> CO CTOR PAVED FRONTAQE <br /> Ali QTH: Ft. X WIDTH Ft <br /> Name <br /> 2 0/ C i✓ <br /> 4^ , The undersigned bmbyes for permission to encroach on County Highway <br /> ppliAdcnsa AI <br /> S Z/C� Right-of-Way on the P'sr side of 1/i�6/G. <br /> fly.; ZSb /mile Som of L-cem209,eDlAV <br /> City,S -Zip Code .�9 ,by installing DW <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submittal) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aco=Tcr App\Form\DdvvmyPaved fin tage <br /> Q <br />