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COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORKS Received byY _ <br /> CR# 0 a <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> 2. 1V%,Y U7 JOB#11005 ISSUEDATV <br /> Name - ".90 _ UZ FEE DUE / <br /> ( vLEXP.DATE DRIVEWAYS: <br /> Addres STREET'ga2t�SA Ripa ' <br /> rxsT a QUAD 5L O <br /> Ci ,State- i de TYPE <br /> FORMS -/7 <br /> (Arta Cod& NOTE ,7—� <br /> SITE INFO TIO <br /> Axl Qin+r5 Nam (�©1' <br /> / Site Address L7 DRIVEWAY <br /> G TYPE QUANTITY. WIDTHS <br /> City,State-Z- <br /> AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Area Code)Tolophono INDUSTRIAL R/W <br /> rESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> X WIDTH: Ft. <br /> v Name �- The undersigned hereby applies for permission to encroach on County Highway <br /> O�j G Right-of-Way on tlu de of �Zt319 R1� <br /> city,State-Zi approxiinately }'Z mile A!o�H of ¢law A R-D <br /> iZ-D. ,by installingyLJ <br /> (Area Code)Tel <br /> Work <br /> will oowmc=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 /> AccessTer AppTormOrivemayfaved ftndage <br />