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COUNTY OF SAN JOAQUIN Date:7/ 2d <br /> DEPARTMENT OF PUBLIC WORKS Received by V- <br /> CR# 052.7& 1 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICA NOFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> APN-L45 -6?0 FEE DUE <br /> l0 M.DATE DRIVEWAYS: <br /> Address STREET if 4-"—OL-r&" <br /> �a QUAD <br /> t t Zip Cod TYPE -D <br /> FORMS�T u✓w� iQ-17 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> arcel 07 r Name L Oca1! A0 15C74141 <br /> Sit Address <br /> � �'� DRIVEWAY <br /> City,State-Zip Code <br /> 2S TYPE TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL , @ R/W <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 theVlleg 74 _side of CBt�n/Va» ,�a! <br /> City,State-Zip Code approximately, feet/ 'le_769, of---4,0,- &Z <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 /> AocessTer Apff orm\DrivewayPaved frontage <br />