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COUNTY OF SAN JOAQUIN Date:__ /�-Z /0 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> C R# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMrr APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#�10 ISSUE DATE <br /> � Name / APN -��U - FEE DUE <br /> �-1 <br /> 7C^ � EXP.DATE DRIVEWAYS: <br /> Address STREET �D!/ <br /> MODLf"n , CA 95'157- 6&# _ _ ��� QUAD <br /> City,State-Zip Code TYPE <br /> FORM <br /> SS Gt�� <br /> (Area Code)yTelephone NOTE <br /> C <br /> SITE INFORMATION N0 / 1 A <br /> �R�JATS i�2uR-AL �2 : � �� / <br /> Parcel Owner's Name <br /> Site Address <br /> z`j9`3 FZA,, G TYPE <br /> P <br /> AIG DRIVEWAY QUANTITY WIDTHS <br /> _ City,State-ZiCode AGRICULTURE @ FRONTAGE <br /> cSC_.hL.�JJ� CA �a3Z� .� £S�� <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> (L 9) '2 ' _ 7'-/4L RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> li m L, 1,,, 0 rZ l SO P LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> '' 0,0,�w— <br /> Address `` The undersigned hereby applies forpermission to encroach on County Highway <br /> b,P F'i, CA UT ) Right-of-Way on the d 2 side of D 2A 4 C A 4%c— <br /> City,State-Zip Code a roximately -7-5; (feaR mile-1=�,A-5;7- ,of <br /> Ci by installing A 'iso rz-A L '2E f i .�SAL <br /> (Area Code)Telephone ��+', �.JAH -� ACN I✓1 C� <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> v � <br /> fi <br /> N <br /> 22 <br /> ° y,° <br /> l <br /> Will this project be self-installed? V—NO YES Contractor's License 793 2 75 . <br /> AccessTer AppTormOrivewayPaved frontage <br />