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COUNTY OF SAN JOAQUIN Date: y /_�p / 07 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0 31 1 S <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> /- APPLICANT OFFICE USE ONLY <br /> (-, ��� ,,d.:�; JOB# 11005 ISSUE DATE <br /> Name APN d 5- i 5 Q - u FEE DUE <br /> S. EXP.DATE DRIVEWAYS: <br /> ,rte r Addre s STREET Q(Q a <br /> ?� , ?��'L�G� AREAQ�Q O QUAD J <br /> City, tate-Zip Code TYPE- <br /> ti:17 <br /> YPE-ti17 ,�? — / -� FORMS w 1� <br /> (Area Code)Telephone NOTE <br /> i <br /> SITE;NFORM�ON <br /> Parcel Owner'Wame��� Z/� <br /> G=am <br /> Site ddress r-� <br /> �� DRIVEWAY <br /> —T City,State-Zi Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE <br /> @ FRONTAGE <br /> / (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ RJW <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for ermission to encroach on County Highway <br /> Right-of-Way on the side of <br /> approximately 0,40 feet! le of aQeA <br /> City,State-Zip Code <br /> Rd. ,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 /> Accew\Per AppTormOrivewayPaved frontage <br />