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COUNTY OF SAN JOAQUIN liaw.l 0 1 1=L u�_ <br /> DEPARTMENT OF PUBLIC WORKS Received by 5;[4 <br /> CR# IS V`- 334'120 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name APN 2-0-1 _ 2.A O _ &1 FEE DUE �D <br /> Hn c l EXP.DATE DRIVEWAYS <br /> Address STREET2i- <br /> Ar QUAD 5 r_- <br /> City, <br /> City,State-Zip Code TYPE <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Site Address <br /> ivy C2 .. r' DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> _ 9 AGRICULTURE @ FRONTAGE <br /> . (Area Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH; Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby es far permission to encroach on County mghway <br /> Right-of-Way on the o �� sick of C ate» <br /> City,State-Zip Code approximately Soo /mile E8S of <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 /> AooessTer ApplForm\DrivewayPaved&vntage <br />