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COUNTY OF SAN JOAQUIN <br /> Received by 6 <br /> ' DEPARTMENT OF PUBLIC WORKS CR# Q 3 O LE-Z. <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNIIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATENme / <br /> ND�- pap _ t FEE DUE <br /> J2A M 1 �f�Us�D N EXP.DATE DRIVEWAYS: <br /> Addresp <br /> STREET <br /> Ln we 9d Z/Vepe QUAD <br /> City,s141te-Zip Code TYPE � <br /> IT ORMS 7 —e l <br /> ea Code)Telephone OTE <br /> SITE INFORMATION /2�cj •/� P <br /> Parcel e <br /> D � b <br /> 11Rte Address DRIVEWAY <br /> D TYPEQUANTITY. WIDTHS <br /> City,S -Zip Code GRICULTURE @ FRONTAGE <br /> L n/ ' COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> '1 © 4- RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH Ft <br /> Name <br /> The undersigned hereby applies for permission to encroach on County High <br /> Address way <br /> Right-of-Way on the . side of�6,2; <br /> City,State-Zip Coda approximately 300 I mile o� f <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 /> AeomTer AppwormorivewayPaved frontage <br />