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COUNTY OF SAN JOAQUIN Date: , <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0 3,- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLIC OFFICE USE ONLY <br /> (j �.��'o'z�, _ JOB# 11005 ISSUE DATE l I <br /> / Npme APN�S -070 -�_ FEE DUE <br /> LZ-- -7� F L i'C: ;�° `'l� EXP.DATE DRIVEWAYS: <br /> �i Address STREET 974W7—A4166 XV. <br /> , ✓</ l_ <br /> City,State`-Zip Code TYPE JC-i 4M • <br /> �� d � 2 ( G/7 � FORMS Q - 17 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION NO F, <br /> Parcel Owner's Name <br /> / Site Ad ess <br /> ,4 //✓�7CN T / %��p2 3(c DRIVEWAY <br /> ty,State-Zip Code TYPE QUANTITY WIDTHS <br /> ;5 / - G y' 7 c/ 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_appliqq for permission to encroach on Co ty Highway <br /> Right-of-Way on the NOC+h side of <br /> City,State-Zip Code approximatel a mileGti(-� of12 <br /> �0 YYUI 1P�_,by installing 2(i <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 /> Aocess\Per AppTormOrivewayEaved frontage <br />