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COUNTY OF SAN JOAQUIN Date: 4'/ <br /> DEPARTMENT OF PUBLIC WORKS Received by .T <br /> CR# D 3 F_ 0Z _ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN o/,7 - 23o - o 4 FEE DUE 41—,60 " <br /> C� S1L1"DP_C1ICJ C(Stil'*-:l ' EXP.DATE DRIVEWAYS: <br /> f�ddrs STREET o � <br /> AREA 4,r-,2m <br /> Ida QUAD <br /> -11 City State-Zip e TYPE <br /> i <br /> ►- cLG R_ A ` '25�& FORMS <br /> (Area Code Telephone NOTE <br /> SITE INFORMATION <br /> i)CK Q V5 " suks i C l�C cam_ <br /> Parcel Owner's Name <br /> igX10 E_ WWr)(4, C <br /> SiteAddress _ <br /> ACA- __A P G , DRIVEWAY <br /> Ci State-Zip Co TYPE QUANTITY WIDTHS <br /> X Q _ 2 r (_Q ti I � AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ 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 5ouA side of W06C1&icd4c. 2a! <br /> City,State-Zip Code approximately /OOUne /mile (•Vssf- ofcfhrttue��: <br /> Y g <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 /> Access\Per Apff orm\DrivewayPaved frontage <br />