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COUNTY OF SAN JOAQUIN Date: /dam <br /> DEPARTMENT OF PUBLIC WORKS Received by ��— <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> -�rAPPLIC OFFICE USE ONLY <br /> I- inn"ell h YZ�WY� JOB#11005 ISSUE DATE, <br /> N e APN 2242- (—- FEE DUE y`'/J� <br /> ✓1 EXP.DATE DRIVEWAYS: <br /> STREET r QUAD <br /> AREA <br /> City,State-Zip Code' ` TYPE ' <br /> I g 3s t I FORMSs Gt>LU l7 <br /> (Area Code)Telephone NOTE <br /> T rn STf,E INFORMAOr <br /> nSEPx. /Uo i/0 C� <br /> Par Owners Name <br /> Sit ss DRIVEWAY <br /> ! 2C� <br /> city,Istate_Z �� TYPE QUANTITY @ WIDTHS <br /> AGRICULTURE FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL Q R/W <br /> RESIDENCE <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 (/OSI- aide of A hl a �- u� <br /> City,State-Zip Code approximately feet mile SerJh 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 /> AccessTear App\FormOrivewayPaved&outage <br /> , <br />