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COUNTY OF SAN JOAQUIDate: // <br /> Received by7�1'5— <br /> DEPARTMENT OF PUBLIC WORKS CR# D 30�� <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> / OFFICE USE ONLY <br /> APP C ISSUE DATE 1 <br /> 1 / �/— FOB5 FEE DUE <br /> 7/r L DRIVEiNA*S: <br /> Addr ✓t� Q lVL�'mUADCity,State-Zip Code <br /> (Area Code)Telephone <br /> SITE INFORMATIO - <br /> IO <br /> parcel <br /> r1 Owners Name <br /> Site AGGless DRIVEWAY <br /> QUANTITY <br /> WH <br /> GRICULTJRE @ FRIDATYPE <br /> GE— <br /> CityState-Zi Code <br /> COMMERCIAL- @ R/W_ � <br /> Area Code)Telephone INDUSTRIAL <br /> SIDENCE <br /> PAVED FRONTAGE <br /> CONTRACTOR GTH: Ft. X WIDTH: Ft. <br /> LEN <br /> Name <br /> ------- The undersigned hereby applies for permission to encroach on County Highway <br /> Address Right-of-Way on the 1//mac side of <br /> approximately_goo _ mile <br /> Of <br /> City,State-Zip Code ,by instalhng <br /> F-- --- <br /> (Area Code)Telephone <br /> _Work <br /> for approximately days. <br /> will commence on or about <br /> SKETCH(Separate sheet may be submitted) <br /> ill this project be self-installed? _NO <br /> YES Contractor's License <br /> Ac=s\Per AppTormOrivewayFaved frontage <br />