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COUNTY OF SAN JOAQUIN Date:Z/_Z,4/ <br /> DEPARTMENT OF PUBLIC WORKS Received by 4$ <br /> DRIVEWAY AND PAVED FRONTAGES cR# <br /> PERMIT APPLICATION <br /> X <br /> APPLICANT + OFFICE USE ONLY <br /> Ci /lC� S G JOB#11005 ISSUE DATE <br /> _ ` Name' APN/515- <br /> EXP.DATE- / o - /9 FEE DUE <br /> DRIVEWAYS: <br /> (_ <br /> Addressv STREET C/au 4,n Auen4,, <br /> AREA S.AaQUAD WE <br /> City,State-Zip Code TYPE p tut, <br /> 22- - Zit S S! FORMS <br /> (Area Code)Telephone NOTE <br /> K SITE INFORMATION. z <br /> Cl iJV� Q--,r—, i(:a_- l?Pr—ri_Z <br /> Parcel Own s Name <br /> Site A ess <br /> C.f4,. `"1 S Z ' (v DRIVEWAY <br /> _City,State-Zi Code TYPE QUANTITY WIDTHS <br /> c,z-c q, y _Z:_ M� AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <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 /Vo r�-h side of 0-4�y h ki 4-enu e- <br /> City,State-Zip Code approximately 2 So /mile 156S,G of MQ W-delta/ <br /> by installing L'Yiirc wau <br /> (Asea 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 /> Access\Per App\Form\DnvewayPaved frontage <br />