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COUNTY OF SAN JOAQUIN Dater/s 0 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# O <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> _ Name APN/05- -220 _ �f S FEE DUE <br /> ' o S I/;,r 1 o h C, j EXP.DATE DRIVEWAYS: <br /> ! Address STREET /ETJgItN Ac, <br /> Ll�l byerferCk AREA 1,1JV.Q-eA1QUAD <br /> City,State-Zip Codi e TYPE Z>L✓ <br /> FORMS ts <br /> (Area Code)Telephone NOTE TT <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> I 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 o Highway <br /> Right-of-Way on the EGS�- side of <br /> City,State-Zip Code approximately Ci 3(, feet/ le r of o Rd, <br /> 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 /> AmessTer AppTormOrivewayPaved froatage <br />