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s <br /> COUN7n'OF SAN JOAQUIN Date: > //S <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR#—� 30 3 2 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name JOB#11005 ISSUE DATE <br /> L OL�'u ��'`"' �' EXP.DATE FEE DUE <br /> DRIVEWAYS: <br /> Address STREET_ <br /> rp " AREA CLtnc-,l QUAD �� • <br /> City,State-Zip Code TYPE ?- �u0 : <br /> . (Area Code)Telephone OTE <br /> do 1 <<l - 3LCfe, <br /> SITE INFORMATION <br /> 11 t 6 Cz - )Vv P!PE <br /> Parcel Owner's Name <br /> Site Address <br /> IL L� C+ S,3-7 b DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> v G - ?, AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL 2 <br /> FUS@ R/W <br /> SIDE=NCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name GTH Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of C'lsbe <br /> City,State-Zip Code approximately 50 mile ofw s <br /> byinstalling s<, <br /> (Area Code)Telephone <br /> will commence on or about Work <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Acc—\Per ApplF0r=0dv-uy1!aved fim"ge <br />