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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by �g <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNIIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> A_,Q.M GpN� Rey--t-,o& JOB#11005 ISSUE DATE 09 / 3 /6706 <br /> Name APN o 61 - OW - 30 FEE DUE Of;,go. Co <br /> _ o X <br /> S.5-/o _ EXP.DATE DRIVEWAYS: <br /> Aaaress STREET AGP/NE ;00,VP <br /> cx1STo N ,C�4 <br /> 9--5- AREASTcxlf ro.0 QUAD—�F�— <br /> City,State-Zip Code TYPE b w Y <br /> 6?0Si6(o- FORMS R- 1? a;/wij <br /> (Area Code)Telephone NOTE <br /> cEu- 118Z — s <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> / y(o /V. AL fire 7z D. <br /> Site Address DRIVEWAY <br /> CA - TYPE QUANTITY WIDTHS <br /> City,State-Zip Code <br /> AGRICULTURE @FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> PNDUSTR]AL @ R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies far permission to encroach on County highway <br /> Right-of-Way on the a side of A/ inG <br /> City,State-Zip Code approximately 400' eet mile No► of ,Z` <br /> 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 /> Will this project be self-installed? NO YES Contractor's License <br /> Access\Per Apff orm\DrivewayPaved&-outage <br />