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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# -3Z,S 6- 7 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATF, <br /> Name APN ZVI - /5-6 FEE DUE /BU <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET 11006-7-468 2D. <br /> X Z-J 2'`f- Esc,ylv,J QUAD dk*w SE <br /> City,State-Zip Code TYPE D- <br /> /� 6�1 5p,4 2,6 FORMS S1 w49S X7-17 <br /> (Area Code)Telephone NOTE —� <br /> co7 `Z - /z '2 <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> / Site Address DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> i-J C,�, AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL _ @ RAV <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 t ,j 4A of Ze"P ree el <br /> City,State-Zip Code approximately. feet/ s� of_ � <br /> by instg <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? NC YES Contractor's License <br /> AccessTer ApplFonn\DrivewayPaved frontage <br />