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COUNTY OF SAN JOAQUIN Date:L8 //'7 /OG <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# �-��— <br /> PERMIT APPLICATION <br /> QPXfLICANT OFFICE USE ONLY <br /> / JOB#PN 'LdMoos <br /> - i `J- <br /> r Name ISSUE DATE <br /> �r <jC'r7 A ` ')7' FEE DUE <br /> / EXP.DATE DRIVEWAYS: <br /> ` CGt ss <� '76 ' STREET LES, s <br /> AREA S <br /> City,State-Zip Code *f Al QUADTYPE 2�;)4 ) <br /> ORMS <br /> (Area Code)Telephone OTE <br /> -- S— <br /> o / ITE FORMATION <br /> ,/Parcel Owner's Name <br /> tn/ .jC t''e-If <br /> Site Address <br /> 1°�Gl Gri (: `r)—1 r✓j DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> .— GRICULTURE @FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> USTRIAL @ <br /> c? I SIDENCE R/W <br /> CONTRACTOR TH. PAVED FRONTAGE <br /> GFt. X WIDTH: <br /> Name Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highwa <br /> Right-of-Way on the side of SCo y <br /> City,State-Zip Code approximatelyfe of <br /> by Inst "K.j- <br /> (Area Code)Telephone <br /> will commence on or about for approximately days. Work <br /> SKETI:H(Separate sheet may be submitted) <br /> r�1 <br /> 4 <br />,yMll this project be self-installed? NO YES Contractor's License <br /> Aocm\Per ApplForm0rivewayPaved fiwtage <br />