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COUNTY OF SAN JOAQUIN Date:9 /14-l 0'7 <br /> DEPARTMENT OF PUBLIC WORKS Received by oel r <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> (OrLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> N APN 253 - f" - /! FEE DUE <br /> Tf ( � �. EXP.DATE DRIVEWAYS: <br /> dre �/r STREET t1, W &4.1 /Qo�G✓ <br /> '1 -r <br /> , i QUAD S W <br /> ty„ ipCode TYPE��,i U��i'_ j FORMS <br /> (Area Code)Telephone NOTE <br /> ORMATION <br /> S' ddress DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> ity,State-Zip Code AGRICULTURE @ FRONTAGE <br /> COMMERCIALArea Code)Telephone INDUSTRIAL @ R/VV <br /> RESIDENCE <br /> ON T PAVED FRONTAGE <br /> C C%1,'�l /1, _ 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 1Ne'S side of ("`I rIS&'z n <br /> approximately 5�o ee 'mile sbuf A of S4: , <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 /> AccessTer AppTormOrivewayPaved frontage <br />