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COUNTY OF SAN JOAQUIN Date: / 3I l 7 <br /> DEPARTN ENT OF PUBLIC WORKS Received by <br /> �3 i <br /> DRIVEWAY AND PAVED FRONTAGES cR# 37C) <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> --hrr8,:Ty� y an i JOB#11005 ISSUE DATE / / <br /> �,\ N e APN j3. -_tZ- _3Z FEE DUE <br /> CLCD 1J �t)I S a EXP.DATE DRIVEWAYS: <br /> Address STREET 'j"V(S Ar Acum._u t <br /> C-) C <br /> S taC tc� ci 2�JS+nC� QUAD iy E # <br /> City,State-Zip Code TYPE Drw,a w�... _ <br /> 21)9Loo I 2L)43 FORMS— <br /> (Area <br /> ORMS—(Area Code)Telephone NOTE <br /> SITE INFORMATION rr <br /> Parcel Owner's Name <br /> Site Address <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ 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 Co ty Highway <br /> Right-Of--Way OII the ('SS� side of J�{g& /1 <br /> City,State-Zip Code approximately 0,32 feet ori-(.s of 'PaDal,% <br /> 11a d ,by installing <br /> (Area Code)Telephone <br /> will commence on or about for approximately days, Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO _ YES Contractor's License <br /> AccessTer A.ppTorm\DnvewayPaved frontage <br />