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COUNTY OF SAN JOAQUIN Date: 7 /3 <br /> DEPARTNIENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Z-2zl ZR2 K� JOB#t 11005 ISSUE DATE <br /> r Name APN/S7 - 2�!2 - OZ FEE DUE � /8 0°O <br /> .,'If/ ` EXP.DATE DRIVEWAYS: <br /> A ckess .^ STREET Alln,61.1 Ar. <br /> O,e �4 ;�_ 6'- 7 S-Lo c k QUAD z55' <br /> City,State-Zip Coda TYPE <br /> Ze;) _- cl s -z i z./ FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INF TJON E� <br /> Parcel er's e <br /> Site Address DRIVEWAY <br /> Ci State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> NDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <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 KGs side of 1_4nL,0 c, � <br /> City,State-Zip Code approximately 7760 mile�t,y�, of / Url7�Y ff <br /> >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 /> Aocess\Per Apfform\DrivewayPaved frontage <br />