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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES cR# O <br /> aq <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#{11005 ISSUE DATF, <br /> / Q Name APN/d l _ _1� FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> 9 7 J f lAddress STREET f{! A • <br /> 7AREA_ ---7re�7"6 QUAD /V, ' <br /> City,State-Zip Code C� TYPE s <br /> /'1 ?--A/ FORMS <br /> (Area Code)Tel hone OTEALA <br /> ITO ?7M7 <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Site Address <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE Q FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ RAV <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Me <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the_(kxSz" side of W917-25 ZA <br /> City,State-Zip Code approximately --'-Sa e D.iCT;V of <br /> � .by installing J> <br /> (Area Code)Telephone <br /> will commence on or about for approximately days, Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aooess\Per Apff orm\DrivewayPaved fiw"ge <br />