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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE <br />USE ONLY <br />Name: <br />NOTES: <br />Address: <br />Cit State <br />Zi Code: <br />TYPE: <br />Area Code - Telephone <br />QUANTITY <br />Number: <br />7-4P <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />GRICULTURE: <br />Site Address; 13j6ej <br />FRONTAGE <br />City, <br />State Zip <br />Code:15c914 <br />Area Code <br />-Tele <br />hone Number: <br />- 4 f• Io <br />CONTRACTOR <br />Name: <br />RESIDENCE: <br />Address: <br />PAVED FRONTAGE <br />City, State <br />Zip Code: <br />Area Code -Telephone <br />Number: <br />Ft, <br />-y-77 7 <br />Date: 7 /o Lo <br />Received By: <br />CR#: O607G/ <br />iereby applies forperm(ssion to excavate, construct and/or ofhenvise encroach on County Highway Righl•of•Way on the <br />side of 'lYwsel a approximately G C C feeUmile P <br />y� f <br />by installing T`+a✓Ltru rSMnIM� <br />Work will <br />commence on or about for approximately days. <br />may <br />Will this project beself-installed? YES d NO <br />P?FNCROACNNEM6VA.�N�fa�m�TamglNeeIENCRMCNMFNi PEflMRUPNEYVTY.Jo�(Wro� <br />Contractor's Llcenae 9`s � �� <br />OFFICE <br />USE ONLY <br />OB #: 11005 ISSUE DATE; <br />APN FEE DUE: <br />EXP, DATE: DRIVEWAYS: <br />STREET: 7wwoem A/ 00 " <br />AREA: p QUAD AIJAI <br />TYPE: /Pa4CME3 2 <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />GRICULTURE: <br />FRONTAGE <br />OMMERCIAL: <br />INDUSTRIAL: <br />1@ R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, <br />X WIDTH: <br />Ft, <br />iereby applies forperm(ssion to excavate, construct and/or ofhenvise encroach on County Highway Righl•of•Way on the <br />side of 'lYwsel a approximately G C C feeUmile P <br />y� f <br />by installing T`+a✓Ltru rSMnIM� <br />Work will <br />commence on or about for approximately days. <br />may <br />Will this project beself-installed? YES d NO <br />P?FNCROACNNEM6VA.�N�fa�m�TamglNeeIENCRMCNMFNi PEflMRUPNEYVTY.Jo�(Wro� <br />Contractor's Llcenae 9`s � �� <br />