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COUNTY OF SAN JOAQUIN trate: 7 1 •� i'• <br /> _ <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE, <br /> Name N 201-9 -630 Z- 3FEE DUE /Ra <br /> EXP.DATE - DRIVEWAYS: <br /> STREET SEXTON � ' <br /> G �o F�� - QUAD 379—F • <br /> 'ty,State-Zi Code TYPE <br /> 5C o 1-3 2 O FORMS - <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> ParceOIWMIIB C .A- G h 4*',(Si <br /> , 2to 0as✓� RIVEWAY <br /> .1112 City,State- ip Code TYPE QUANTITY- WIDTHS <br /> / S 2 c7AGRICULTURE @ FRONTAGE <br /> (Afea,Code)Telephone COMMERCIAL <br /> q / <br /> INDUSTRL4LL (a3 R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENOTIE Ft. X WMITU Ft. <br /> Name <br /> Address The undersigned hareby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of 25. <br /> City,State-Zip Code approximately 3 �i�� of_� - iW—Z <br /> Zo -by installing T L✓ <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 /> Access\Per App\Fofm\DrivewayPavad&mtage <br />