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� COUNTY OF SAN JOAQUIN Date: _/ <br /> I&EPARTMENT OF PUBLIC WORKS 0 Received by <br /> DRIVEWAY& PAVED FRONTAGES CR# ¢2 O - <br /> PERMIT APPLICATION <br /> APPLICANT <br /> 1 OFFICE USE ONLY <br /> _ Name JOB # 11005 ISSUE DATE / <br /> APN 2 - - FEE DUE <br /> Address EXP. DATE -/ DRIVEWAYS: <br /> l , T-r//J 04- S_ i STREET <br /> City,State-Zip Code AREA .9 QUAD Ste- <br /> t5e Y, sS <br /> TYPE l9,e/U �> <br /> (Area Code)Telephone FORMS S S 47 C.✓ -j 'z <br /> NOTE <br /> SITE INFORMATION <br /> "Parcel Owners Name DRIVEWAY <br /> 7 ., <br /> Site Address TYPE QUANTITY WIDTHS <br /> 1 ►�i� E�4 C aj- `.�-" ? i AGRICULTURE @ FRONTAGE <br /> City,State-Zip Code COMMERCIAL <br /> 7 G ' T - •- 1-'=C_ INDUSTRIAL <br /> R/1/V <br /> (Area Code)Telephone RESIDENCE Z— <br /> C0NTRACTOR <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 Highway Right-of-Way on the moo' side of <br /> u//io approximately <br /> (Area Code)Telephone 6 fee mile ou of '(r el. <br /> by installing <br /> Work will commence on or about 3//0 /9 for approximately / 9-() <br /> days. <br /> SKETCH (Separate sheet may be submitted) <br /> -- ---- -------- <br /> �C-- <br /> z <br /> Will this project be self-installed? NO YES Contractor's License <br />