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COUNTY OF SAN JOAQUIN Date: , / i�/-& <br /> Received by jat-- <br /> DEPARTNvtENT OF PUBLIC WORKS CR# O 32_'7 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN 2s;S'- I6-9 _2� FEE DUE <br /> �p DRIVEWAYS: <br /> JY� S <br /> Cal- S12 EXP.DATE <br /> Address STREET <br /> i � V�olek SIG �- �y QUAD S� — <br /> City,State-Zip Code TYPE <br /> cA 963'1-7 FORMS <br /> (Area Code)Telephone NOTE <br /> Zoe, A0 <br /> SITE INFORMATION <br /> S_._., <br /> Parcel Owner's Name <br /> o- 'icr R,p <br /> Site Address c��0 LI DRIVEWAY <br /> TSZ �Y r TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIAL @ R/W <br /> (Area Code)Telephone INDUSTRIAL <br /> 20 Cn 22, _ LIP RESIDENCE �- <br /> 1 J 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 �(/l8 side of ;Gong • <br /> C132� <br /> approximately U,So feet/(V AIDE{fir of J)ernG/r__S-2W <br /> City,State-Zip Code ,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 /> Access\Per App\Form\DrivewayPaved frontage <br />