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C-/ <br /> COUNTY OF SAN JOAQUIN ha`e: <br /> Rw6ved by <br /> DEPARTMENT OF PUBLIC WORKS C R# ®3) <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> C4_�/7_zJ COP JOB#11005 ISSUE;DATE <br /> Name APN i?f - ?/f _ a FEE DUEi'�/c J <br /> �7 �� , EXP.DATE DRIVEWAYS: <br /> ss STREET _A ,,r G <br /> L q S L,0� AREAs tz�c r7� QUAD <br /> Ci tate-Zi Code TYPE <br /> ty FORMS <br /> / <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION /ms's /01PE g <br /> Parcot hr's Name //) <br /> ST ite mess �S u_ DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City, tate-Zi Code <br /> 'Z 2� <br /> G07 <br /> City, @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> NDUSTRIAL @ R/W <br /> RESIDENCE <br /> COFACTOR PAVED FRONTAGE <br /> A-)5 GTR Ft. X. WIDTH: Ft. <br /> Name <br /> ep- The undersigned hereby applies es for permission to encroach on County Highway <br /> C'j s Right-of-Way on the F.as l side of�l Cl u r�I S_l/eg,04 <br /> City,State-Zip Code approximately /So ( /mile .So afh of Seven Ah f <br /> by installing <br /> (Area Code)Telephone <br /> z© 9 � <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 /> A oo—Ter App\FormUk vawayNved HBe <br />