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COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORKS Rmciy vTed by <br /> CRS V+a cJ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name 2V - /!oo -z9 FEE DUE <br /> V EXP.DATE DRIVEWAYS: <br /> Address STREET SE/Dn�i2 .2oAs� • <br /> $?(c7 cs,Mavrr'6 Vrcm A V6 QUAD'_ <br /> City,Stat -Zip Cie TYPE <br /> FORMS 5_TGw� .e-17 <br /> �OGI 62 Z hone OTE <br /> SITE INFORMATION <br /> Parcel Ovmmt Name ' <br /> J A2t=� o�+L akT_e:?_ <br /> Site Address <br /> (� 2 s r b :r DRIVEWAY <br /> City,State-Zip TYPE QUANITTY- WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (--,4 f= <br /> ( on <br /> •Code)Tolopho COMMERCIAL <br /> u �7USTRIAL R/GV <br /> l 1 1 I 1 <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH`. FL X WIDTH: It <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County highway <br /> Right-of-Way on the side of G <br /> City,State-Zip Code appwx m ely r� Aift' : o_: '' of 40 <br /> by insta g <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Soparate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's Lioense <br /> Acoeas\Per AW\Form\Ddvewayf&ved£rootage <br /> s <br /> 6,4 <br />