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COUNTY OF SAN JOAQUIN Date: I I/ / /® <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# - Z <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLIC OFFICE USE ONLY <br /> S�2i rxS o i-0 69f �lC JOB# 14005 ISSUE DATE l 1 <br /> ¢¢ ,, ame ® APN% - 3G0 - FEE DUE <br /> iC4,:, LS EXP.DATE DRIVEWAYS: <br /> Address T STREET E�17 <br /> cls 195Z-32- uA-Zk 0 QUAD Xr <br /> City,State-Zip Code rOTE <br /> 9 ` <br /> S 55 l+il", /G — <br /> (Area Code)Telephone -T— <br /> SITE INFORMATION mo l ��&, <br /> A=d, i�-' <br /> Parcel Owner's Namev <br /> f Site Address DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE A <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 theside of A&& 26o d <br /> City,State-Zip Code approximately eet/mile C, of .base ��ver L✓j, <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 /> Access\Per App\FormOnvewayEaved fi-ontage <br />