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COUNTY OF SAN JOAQUIN Date:_1A ka�y <br /> DEPARTMENT OF PUBLIC WORKS Received by_ <br /> DRIVEWAY AND PAVED FRONTAGES CR# G 3 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ZD ISSUE DATE, <br /> Name APN<®-'> - 2111 - FEE DUE SBD <br /> wz^L. C P EXP.DATE DRIVEWAYS: <br /> Address STREET V1 'Gf/ <br /> 4/ I D[,' YA !c I4 A cl QUAD A/E <br /> City,State-Zip Code TYPE Z-;W <br /> L. !NDE 1V G A 75--2 3 6 FORMS 575 w u . 2 -!7 <br /> (Area Code)Telephone NOTE � T <br /> 029- -O.6 <br /> SITE INFORMATION <br /> � � e <br /> Parcel Owner's Name <br /> jAM Site Address <br /> �.1 DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> ]NDUSTRIAL @ R/W <br /> SIDENCE s/ <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permissionn to encroach on County Highway <br /> Right-of-Way on the Nkg f- side of L)tt-kric h Rax d <br /> City,State-Zip Code approximately 6.30 feet/�1 A 36ru-, of '!6 gQfMCb�s pet. <br /> by installing I I <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 /> Aoo—CPQ App\F—WdvewayPavad frontage <br />