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COUNTY OF SAN JOAQUIN Date:/0 / S / Ow <br /> DEPAR'TNENT OF PUBLIC WORKS Received by 20-7 <br /> DRIVEWAY AND PAVED FRONTAGES CR# D S705-2-5142 <br /> PERMIT APPLICATION <br /> 4WLICANT OFFICE USE ONLY <br /> l [ eau JOB# 11005 ISSUE DATE <br /> Name APN 15-3_14 - Ol_ FEE DUE 'X00 <br /> T <br /> (� �(�JvQrr�t7C�N S EXP.DATE DRIVEWAYS: <br /> Ad(�s� STREETaSA�� /i.c �760 <br /> �T QUAD LcS <br /> AREA Q s <br /> City,State-Zip Code TYPE W <br /> cY S V 5s _ ? ORMS iVw. ,e/ <br /> (Area Code)Telephone NOTE <br /> SITE ORMATION <br /> �-le 1`"i �P <br /> i Parcel Owner's Name _ <br /> Site Address <br /> :S7 DRIVEWAY <br /> City,State-Zi Code TYPE QUANTITY WIDTHS <br /> r g c7AGRICULTURE @FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> RqDUSTRIAL / @ g/W <br /> RESIDENCE �- <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: 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 mer,y side of i ?dn! ST, <br /> City,State-Zip Code approximately /' 6 -zL/"57-of zzg?o "91,05, <br /> by installing_ 7>GJ, <br /> (Area Code)Telephone <br /> will commence on or about for approximately days. Work <br /> SKETCH(Separate sheet may be submitted) <br /> ' b' <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aecess\Per ApplFormlDnvewayTaved&outage <br />