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COUNTY OF SAN JOAQUIN Dater/ l i <br /> DEPARTMENT OF PUBLIC WORKS Received by ZLJ a <br /> CR# e9 313(i 2 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNIIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN is L- 3�70 - Q G FEE DUE <br /> o L --�)v 17gleYv EXP.DATE DRIVEWAYS: <br /> Address Q'� STREET A ©_`� `l?D <br /> 3 N i � 4[U QUAD -5 <br /> City,State-Zip Code TYPE DV--N F.W A <br /> O+K DALC C.f 1 �—A,/_ FORMS SS ow ��-17 <br /> (Area Code Telephone Code) NOTE <br /> z� 7�P5`5 3.5-3 <br /> SITE INFORMATION <br /> 7oLif0c; Q'zt/i-CQ <br /> Parcel Qwner's Name <br /> zF- <br /> Site Address <br /> S o,\,° � DRIVEWAY <br /> City,State-tip 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 on County Highway <br /> Right-of-Way on the side of At. <br /> City,State-Zip Code approximately o=Go feet mile ea%4- of Ion- <br /> by installing Dy✓ <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 /> Aoc='Ter AppTormOrivewayPaved frontage <br />