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r <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTIMENT OF PUBLIC WORKS Received by <br /> O (p <br /> DRIVEWAY AND PAVED FRONTAGES CR# <br /> PERNUT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATF, <br /> Name APNA95-_- 270 -0_ FEE DUE _ 275; �— <br /> STE✓ ,eg5E .DATE DRIVEWAYS: <br /> Address STREET Ftl aeLAIVE Rb. <br /> FA1k4AnX AREAAQq—AmAo QUAD_ <br /> City,State-Zip Code TYPE <br /> AcAn�PD, 5 22oFORMS� <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION one �`u- W��h /�•�,�,,(� GAP t v r, ,�' <br /> Parcel Owner's Name /Z r7" <br /> Site Address <br /> 5 a3 E. Fi 19Z4NE ,2t7. DRIVEWAY <br /> Ctate-Zip Code TYPE QUANTITY WIDTHS <br /> iS <br /> �q/yJ S AGRICULTURE Qa FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE X <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The Undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the_ &L4side of , <br /> City,State-Zip Code approximately /--% mile L00--37— of CrIrI i <br /> ,zZ�)_ .by installing pe—) <br /> (Area Code)Telephone <br /> will commence on or about for approximately days, Work <br /> SKETCH(Separate sheet may be submitted) <br /> #Fill this project be self-installed? NO YES Contractor's License <br /> Ace—\Per AppWormOrivewayPaved 8nntage <br />