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Date: _/ <br /> COUNTY OF SAN JOAQUIN Received b;_ <br /> DEPARTMENT OF PUBLIC WORKS CR#<>3� - <br /> DRIVEWAy AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> APPLICANT #11005 ISSUE DA��43- <br /> JOB FEE DUE <br /> N 5_-z- DRIVEWAYS: <br /> 29 DRIVEWAYS: <br /> ame � =./ EP.DATE s <br /> l/ STREET �llef <br /> Addre s Gon/ QUAD W_ <br /> City,State-Zip Code TYPE s5 <br /> ORMS <br /> (Area Code)Telephone OTE <br /> SITE INFORMATION NO P/Pe <br /> C- SN <br /> P&�1-2 L/- <br /> Site Address DRIVEWAYQUAY, WIDTHS <br /> 3 e C TYPE @ FRONTAGE <br /> City,State-Zip Code Z �� GgICULTURE <br /> LG lJ J 1 COMMERCIAL @ R/W— — <br /> (Area Code)Telephone INDUSTRIAL <br /> r ��1 � SIDENCE <br /> CZ PAVED FRONTAGE Ft. <br /> CONTRACTOR LENGTH: Ft. X WIDTH: <br /> Name <br /> lies for permission to encroach on County I-Ti&"y <br /> The undersigned hereby applies P�� e l,./o.. P.,/ <br /> Address Right-of-Way on the side of <br /> n.3 p feet/ A/orf1+ of <br /> approximately�_ <br /> City,State-Zip Coda ,by installing <br /> (Arca Code)Telephone <br /> Work <br /> days. <br /> will commence on or about <br /> for approximately"11 <br /> SKETCH(Separate sheet maybe submitted) <br /> Will this project be self-installed? <br /> NO YES Contractor's License <br /> AWM\Per A,,\Form\DdvewayPaved f vdage <br />