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COUNTY OF SAN JOAQUITT Date: �" I i <br /> DEPARTMENT OF PUBLIC WORKS Received by CR# 0:5 6 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERma APPLICATION <br /> App CANT OFFICE USE ONLY <br /> it rn t ti t ) JOB#11005 ISSUE DATE <br /> Name N rl S - /vE _ FEE DUE <br /> t9 1 EXP.DATE DRIVEWAYS: <br /> Address STREET -Z_rLTA f,'li�5- <br /> �/ QUAD " <br /> (/\, City,State-Zip Code TYPE ` <br /> FORMS s�� <br /> (Area Code)Telephone NOTE —T <br /> SITE INFORMATION <br /> ParK1Ownei' arae <br /> / S'a Addr as DRIVEWAY <br /> TYPE QUANTITY. WIDTHS <br /> City, de-Zip Code GRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> RESIDENCE t <br /> CONTRACTOR PAVED FRONTAGE <br /> GTR- 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 k6rAh side of _ <br /> Of <br /> City,state-zip Code approximately 1/z feet/ W� <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 /> AccessxPer AppTormTkivewayPaved frontage <br /> - ,1 <br />