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COUNTY OF SAN JOAQUIN Date: 5' /75- <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# O a Z- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#�110'05 ISSUE DAIT, i I <br /> ame APN r -Z40_ Z® FEE DUES�— <br /> I e Y YiCt 0)X�Z EXP.DATE DRIVEWAYS: <br /> Address STREET LO ICA <br /> 75- to , I{j G �lT.+�h01 QUAD SE <br /> City,State-Zip Code TYPE <br /> l 1 h rel n 0A.. 9,3 Ci FORMS 1�' a <br /> I—(Area Code)Telephone NOTE <br /> �20q -I <br /> SITE INFORMATION <br /> Parcel er's Name <br /> r ✓� <br /> Site Address <br /> 3 X56, DRIVEWAY <br /> City,State-Zip Code TSE QUANTITY WIDTHS <br /> AGRICULTURE @ <br /> FRONTAGE <br /> COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL _ @ R/W <br /> [RESIDENCE _ 2K <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 6&rside of K16 2aa d <br /> City,State-Zip Code approximately SSO ee mile of Bnl-A, C <br /> by installing D <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 /> AccesslPer App\Fc=\DrivewayP-aved fi—tage <br />