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OF SAN JOAQDate:_ <br /> UIN <br /> COUNTY Received by <br /> DEPARTNiEN'r <br /> OF PUBLIC WORKS CFO <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> OFFICE USE ONLY <br /> APPLICANTISSUE DA <br /> Tf <br /> JOB#11005 FEE DUE , <br /> APN�- a AO - a a <br /> DRIVEWAYS. <br /> Name moi'3 a EXP,DATE <br /> P ° STREET R • <br /> Address 38 – <br /> A �s �__ <br /> G�IGSTLE `" TYPE <br /> ity,State-Zip Code ORMS GeJ�eJ <br /> Telephone OTE <br /> (Area Code) eP <br /> SITE INFORMATION <br /> Parcel Owners Name <br /> Site Address ��3��! DRIVEWAY QUANTITY WIDTHS <br /> �--� G <br /> CiTYPE @ FRONTAGE <br /> ty,State-Zip Code GRICULTURE <br /> Ub ---- COMMERCIAL @ <br /> (Area Code)Telephone STRIAL <br /> SIDENCE <br /> PAVED FRONTAGE Ft. <br /> CONTRACTOR LENGTH: Ft. X WIDTH: <br /> Namession to encroach on County ITighwaY <br /> -- The undersigned hereby applies for perms <br /> Address -Way on the G�a,� side of of �1M <br /> t V feet/� /1/vrt <br /> approximately—binstalliz►g <br /> City,State-Zip Code Y <br /> (Area Code)Tclephone <br /> Work <br /> days- <br /> for approximately <br /> will commence on or about____ <br /> SKETCH(Separate sheet maybe submitted) <br /> self-installed? __ <br /> NO YES Contractor's License <br /> Will this project be <br /> AcMSTex AMM M\DrivewayPavad footage <br /> ,1 <br />