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COUNTY OF SAN JOAQUIN Data 11ST/ow <br /> Received by <br /> DEPARTMENT OF PUBLIC WORKS <br /> CRO <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> APPLICANT 70B#11005 ISSUE DATE <br /> Name APN K-0-30 FEE DUE <br /> 'fGS DRIVEWAYS: <br /> � C � s / ' <br /> Address STREET QUADAREA <br /> - — s <br /> City,State-Zip ,.> TSE D``� <br /> �l FORMS <br /> / <br /> h OTE <br /> ( a de)Telephone <br /> srm INFORMATION <br /> Parcel Owncr's Name <br /> 6�5-DZv_3Q vy <br /> Si a Address DRIVEWAY <br /> TYPE QUANTITY �T� <br /> ' f City,State-Zi Co AGRICULTURE @FRONTAGE <br /> `V DOQ�! COMMERCIAL <br /> ,(Area Code)Telephone USTRML Q° RIVV <br /> SIDENCE <br /> PAVEDFRONTAGE <br /> CONTRAC OR Ft. X WIDTH: Ft. <br /> c r G ALL H LENGTH: <br /> Name <br /> �f lS <br /> 11ww) The undersigned he�0- <br /> / <br /> mission to encroach on Co}mty Iii y <br /> Address Right-of-Way on thsilo of y►'� <br /> app tely2aaLAI— <br /> le ems_—of <br /> City,State-Zip Code by installing <br /> (Area Code)Telephone <br /> 1131- 3b <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 /> AecenTer Apff orm\DrivewayPaved ftcdage <br />