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COUNTY OF SAN JOAQUIN Date:,f /.;o —i57 <br /> Received by f 1 <br /> :DEPARTMENT OF PUBLIC WORKS <br /> CRN C3`�2 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> �KA 4 Ci JOB# 11005 ISSUE DATE <br /> Name APN -1 t - 7� - 5� FEE DUE <br /> 11z ���? N t f"1.L�K S{ EXP.DATE <br /> , DRIVEWAYS: <br /> Address STREET i <br /> x�i c CA 502 0C^o G QUAD s <br /> City,State-Zip Code TYPE <br /> DMILU <br /> A(PoZ — —I S FORMS — <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION �� _ <br /> Cil lCk `GL�tiSldf <br /> � <br /> Parcel e s Ne <br /> ;20 -7 t; <br /> Site Addres DRIVEWAY <br /> �OCk n 1 CA �S 0.6 �� TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @° RIW <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 ide of S � levT <br /> approximately �00 �/mile Cir s f of ii � : S+� <br /> City,State-Zip Code -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 /> AccessTer App\Form\DrivewayPaved frontage <br />