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COUNTY OF SAN JOAQUIN Date: / 6 , <br /> DEPAR'TWMNT OF PUBLIC WORKS Received by / <br /> DRIVEWAY AND PAVED FRONTAGES CR# O � — <br /> PERMIT APPLICATION <br /> — PLICAN� , <br /> OFFICE USE ONLY <br /> Name JOB#11005 ISSUE DATE, <br /> Z "'�4 JVI 1 -�- AP N�L- X60- v Z- <br /> 7 ���" t EXP.DATE FEE DUE 66 <br /> Address� / DRIVEWAYS:,A aAg S MEET_Mtt>SF,c� ia*S s ae <br /> CitY �t p Code e =Cl+c�2t,'3"ey� QUAD _ • <br /> e1� TYPE <br /> 'r ORMS -/ <br /> (Area Code)Telephone , 2 YYOTE <br /> r <br /> / SITE INFORMATIONZTA <br /> --� <br /> Parcel Owner's Name <br /> Site Address 7*N4 01;7 <br /> 9 �0 DRIVEWAY <br /> City, tate-Zi Ce TYPE QUANTITY <br /> •�� � �y� � ^' �TtGRICULTURE WIDTHS <br /> (Area Code)Telephone COMMERCIAL @ FRONTAGE <br /> NDUSTRTAL <br /> SIDENCE @ R/W­� <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name GIH: Ft. X WIDTH: <br /> Ft. <br /> Address The undersigned hereby applies for <br /> Right-of-Way on the T Permission to encroach on County Hi waY <br /> City,State-Zip Code approximatelyside of_�t aSEGZ�D �., <br /> ?-fib eg itlOr�T of <br /> (Area Code)Telephone — by rust -- } <br /> will commence on or about <br /> for approximately <br /> days. Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO <br /> YES Contractor's License <br /> Aooew\per App\FamlDrivewayPavm¢outage <br />