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COUNTY OF SAN JOAQUIN Date:/ �, /0-7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# d3 2 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE— <br /> Name APN275 - /5 - 4a% FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> C Address e STREET �z jal �7L�. <br /> C QUAD <br /> City,State-Zip Code— TYPE -C>t <br /> R T=S-22K z 5 5 FORMS ' l�t,0, /-Z-17 <br /> ea Code)Telephone NOTE T— <br /> SITE INFORMATION <br /> I Pel , er's Name F— <br /> pT b'K 1` +�r A.(Ci •��reti ni <br /> Site-Address <br /> DRIVEWAY <br /> City,Stat - Code TYPE QUANTITY WIDTHS <br /> Cvim '` Fes- AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL@ RAV <br /> �7 <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 CoHighway <br /> Right-of-Way on the s� side of A ' unt G-e <br /> City,State-Zip Code approximately S"o e /mile f Off// Bv;e <br /> by installing du y <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 AppTormOrivewayPaved frontage <br />