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COUNTY OF SAN JOAQUIN Date:-Z/—l /5 / o6 <br /> .?: <br /> DEPARTMENT OF PUBLIC WORKS Received byCR# 30 88S <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> N e APN - 13 t - d 3 FEE DUE �D W <br /> EXP.DATE _ DRIVEWAYS: <br /> STREET Q <br /> 1 , , ` ddtess , \ QUAD. ' <br /> `-t N _ AREALod. <br /> City, e-Zi <br /> ` TYP <br /> P E <br /> FORMS 0 &7 <br /> (urea Code)Telephone NOTE <br /> SITEINFORMATION �p pfPg <br /> Parcel Owner, Name / <br /> �A?C nC 0 K1?J(1� <br /> 2 Site Address [ DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> r Ci State-Zip Code /� GRICULTURE @ FRONTAGE <br /> qS —in_ COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @° R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X. WIDTH: Ft. <br /> ame <br /> ~ S The undersigned hereby applies for permission to encroach on County Highway <br /> Address Right-of-Way on the side of .,vru <br /> 0.46 feet/ ' <br /> Cityapproximately,State-Zip Code ,by installing <br /> ()Area Code)Telephone <br /> Z - I 1 `T <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 /> Accea Ter AppwormorivewayPaved f u"ge <br />