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COUNTY OF SAN JOAQUIN Date:./A/ d 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> C R# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> 0-t— JOB# 11005 ISSUE DATE <br /> Name APN/59 - 1"- FEE DUE <br /> -s CA EXP.DATE . �j DRIVEWAYS: <br /> Address STREET / i <br /> �3?t1G.�`r0 A l QUA �S— <br /> City,State-Z. Code TYPE <br /> 2 o --zO �C�2FORMS Srf lVwi "I — <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> t�lSfuur��,�. S� . <br /> Site Address , DRIVEWAY <br /> G"", t S Z, TYPE QUANTITY WIDTHS <br /> ll City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> S-� 1)—a G2`2) COMMERCIAL <br /> Area Code)Telephone INDUSTRIAL @ R/W <br /> RESIDENCE <br /> ------------ <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 W-96 iv�vl 54, <br /> City,State-Zip Code approximately 00 ' ee mile Else of t4sk v a/ Ave <br /> by��8 <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 /> Acc=\Per AppTormOnvewayPaved firontage <br />