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COUNTY OF SAN JOAQUIN Date: Ao/zav <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: +• U <br /> Address: '-ArJOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 9 . 3 Z. APN '905--Z/0.07 FEE DUE: 2d 6' <br /> Area Code -Telephone Number: W_ , -3g,Y EXP.DATE: DRIVEWAYS: <br /> STREET: y� <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: :iAA TYPE: x <br /> 19, Site Address:273c'y N K� r. h? FORMS: y, <br /> City,State,Zip Code: C1f1 3 NOTES: <br /> Area Code -Telephone Number: 2,011 / 31� <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY I WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Tip Code: INDUSTRIAL: RAW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for pe�1ss.!on to_expavate,construct and/or otherwise en ach on County Hi ay Right W on the <br /> ide of erti4 r:% 1d. approximately � ��� <br /> Of by installing <br /> Work will <br /> commence on or about _ for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> M;ICENTRALSERVICESICLERICALPUBSV.WK'wMASTER.PSt,ENCROACHMBNT PERWT DRIVEWAY.DOC )10/09) Page 1 of 2 <br />