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COUNTY OF SAN JOAQUIN Date: / / � D� <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES 3 <br /> PERMIT APPLICATION <br /> APPLICANT-? OFFICE USE ONLY <br /> �,� JOB# 11005 ISSUE DATE / / <br /> y� $me_ APN 19 3 - O 6JO - 0/ FEE DUE <br /> /D�O J �C�Lf �✓ D`�' ENP.DATE DRIVEWAYS: <br /> ddress STREET_1-19j�.4an hbad ' <br /> AREA �k .n L^ �`g naT;i QUAD S9 <br /> Stag Zip Code q �� ,�� TYPE 0 w W — <br /> FORMS SS cu,,c.) <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> LSWinz �' No f?iPC"s <br /> Parcel Owner's Name <br /> Site Address DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @a FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <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 wgp-_� side of Nlkan 4L <br /> City,State-Zip Code approximately (QSv � /mile S6L,4A of Fvemch <br /> 0,4. >by installing <br /> (Area 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 /> AccessTer AppTarmlDrivewayPaved frontage <br />