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COUNTY OF SAN JOAQUIN Date2e //3/ <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# � <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> 9A OFFICE USE ONLY <br /> ` U F;N <br /> ISSUE DATE <br /> Name 80 - FEE DUE -i /9,;i'res c� DRIVEWAYS: <br /> s <br /> s C1AREk <br /> S 9 3 STREET QUAD S� <br /> _ 'e— c� ORMS d�� <br /> 0 <br /> (Area Code)Telephone OTE <br /> SITE INFORMATION A10 d /d/PC <br /> W � Parcel���jName �,O <br /> p to A ess DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City,Stat(` Zip �Code AGRICULTURE @ FRONTAGE <br /> ` � ✓ <br /> (Artie Code)Telephone COMMERCIAL <br /> NDUSTRIAL @ R/W <br /> RZESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name �-- <br /> �� The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the aide of lae <br /> ,C`i'ty,S approxictmately -3= emile 5ou-fh of , <br /> n oc •by installing <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> fill this project be self installed? -NO YES Contractor's License <br /> AocemTer AppTorxnJ)ivewayPaved fi adage <br />