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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# <br /> PERNM APPLICATION <br /> ^ APPLICyANT OFFICE USE ONLY ,,.�.--yy <br /> +� n JOB# 11005 n ISSUE DATE / 3 /(XJ <br /> Name APN�% - - FEE DUE _ <br /> EXP.DATE DRIVEWAYS: <br /> Y _ Address <br /> •� STREET <br /> � � <br /> QUAD A/ " <br /> City,State-Zip Code TYPE <br /> 64- `t 5�l o FORl�iS �-s ��✓tc1 -�, <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Site Address <br /> 2 3z/<-l3 C-,r- V,4-1-, DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> -- � <br /> 6r4- 1 S 2 ZU AGRICULTURE <br /> @ FRONTAGE <br /> (Area ode)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> cil ZRESIDENCE d <br /> CONTRACTOR PAVED FRONTAGE <br /> Name FGTH: Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the WCs f' side ofe <br /> City,State-Zip Code approximately Z,app _�y�e (, of <br /> by installing I>iivacy2+�.� <br /> (Area Code)Telephone <br /> will commence on or aboutfor Work <br /> approximately Sys, <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AccessTer AppTorm0rivewayPaved&m"ge <br />