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COUNTY Ur•SAN JUAQUIN Alec • . <br /> Received by <br /> DEPARTMENT OF PUBLIC WORKS CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPIIC OFFICE USE ONLY <br /> �•i, F f" `' VJOB#11005 ISSUEDATEName L$i - Zia - 03 FEE DUEDATE DRIVEWAYS: <br /> a Pr <br /> Address EET P 1� s <br /> L S� %t9�� QUAD 1�E _ <br /> City, ta�_ vCode TYPE <br /> _ FORMS- <br /> (Area Code)Telephone OTE <br /> SITE 11!hF9 N <br /> Parcel Owmes Name <br /> _ Site s DRIVEWAY <br /> TYPE QUANTTPY. WIDTHS <br /> City, tate-Zip c <br /> AGRICULTURE (a3 FRONTAGE <br /> (Area Code)Telephone COMIviERCIAL <br /> PNDUSTRIAL @ R/W <br /> rIDE110E • <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH Ft. X WIDTH: Ft <br /> Name <br /> Address The undersigned hereby applies for permission 4 fP`?O <br /> on to,encroach on County Iiighiway <br /> of <br /> g Yyapproximatel5d of CD 2JL1 <br /> City,State-Zip Code .by iristalling ,J <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 /> AccessWer AppTorm\DdvemyPaved&mtage <br />