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DCOUNTY OF SAN JOAQUIN Date: / 130 <br /> EPARTMENT OF PUBLIC WORKS • Received by <br /> DRIVEWAY& PAVED FRONTAGES CR# <br /> PERMIT APPLICATION <br /> ' APPLICANT <br /> OFFICE USE ONLY <br /> Va�I Name JOB # 11005 ISSUE DATE <br /> / <br /> S• I✓t K APN 193 FEE DUE <br /> Address EXP: DATE —/ '' DRIVEWAYS: <br /> STREET 'S;� <br /> CrY'�"� C' ,State-Zi Code a AREAS=.�rx. 'C�, rr� QUAD <br /> cr�T/ TYPE 41r; rcr�� — • <br /> (Area Code)Telephone FORMS <br /> NOTE —7 <br /> SITE INFORMATION <br /> Parcel Owners Name DRIVEWAY <br /> Site Address ( TYPE QUANTITY WIDTHS <br /> Cfl,(ik m e CA-Qi23 1 AGRICULTURE @ FRONTAGE <br /> City,Stat -Z p Code COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address <br /> The undersigned hereby applies for permission to encroach <br /> City,State-Zip Code on County High ay Right-of-Way on the '4.5 �--side of <br /> P,-/,c'S t- approximately <br /> Tele <br /> (Area Code)Telephone <br /> , feet-/mile of Gi/x <br /> by installing <br /> Work will commence on or about -- — y for approximately ?0 days. <br /> SKETCH (Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br />