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COUNTY OF SAN JOAQUIN Dqa e: 7 ; 7N,, / UP <br /> DEPARTMENT OF PUBLIC WORKS =�ei eived by <br /> �c <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUF?DA <br /> Z nAPN y!�V - -D� M DUE <br /> lel GU C� EXP.DATE _ DIZRrEWAYS: <br /> A ss , STREET <br /> A U _ AREAS7-a enkTon/ QUAD <br /> City Staf e-Zi Code TYPE Dw ` <br /> dY"2 0. L" ^ <br /> ORMS SS tt/t.✓� �' /7 <br /> T <br /> (Area Code) /ehone OTE <br /> SITE INFORMATION <br /> Parcel .Owner's arae <br /> S'te A esa DRIVEWAY <br /> d s y TYPEQUANTITY WIDTHS <br /> Ci 1. <br /> ,State- p GRICULTURE Q FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ FJW <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGT11________jt- X WIDTH:_ Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County highway <br /> Right-of-Way on the side of 4&Crle /41w. <br /> City,State-Zip Code approximately ?•Cd mild i� of Dan A " <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 /> A—Tar App\Form.\DrivewayPaved frontage <br /> ,1 <br /> r�. <br />