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COUNTY OF SAN JOAQUIN Date: /I l <br /> DEPARTMENT OF PUBLIC WORKS Received bye <br /> CR# o A � <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> _ JOB#11005 ISSUE DATE <br /> APN Al FEE DUE <br /> I�1 EXP.DATE DRIVEWAYS: <br /> Way AddressI' STREET QUAD /* - ' <br /> City,S C TYPE �✓ ' <br /> % FORMS G✓w <br /> Q-,�Mca T 1 h NOTE �— <br /> SITE INFORMATION /2 Y C.M /C R p <br /> Parcel Ownces Name / <br /> �_1� -Site Address per,, <br /> Ct�©i �Q.� .1 r im'1 DRIVEWAY <br /> ity,S -Zip �- TYPE QUANTITY WIDTHS <br /> C <br /> GRICULTURE @FRONTAGE <br /> Pip ea el hone 60. COMMERCIAL <br /> �� J� `�� � INDUSTRIAL @�' <br /> iRESIDENCE <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 f► side of F}?2 itr Rd. <br /> City,State-Zip Code approximately O.S'a feet ra-� i5-iaj- Of r eA4S a/ <br /> by installing Dr. <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> /2y <br /> Will this project be self-installed? NO YES Contractor's License <br /> AmmslPer Apff orm\DrivewayPave3 ftodage <br />