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FA <br /> COUNTY OF SAN JOAQUIN Date:a_/ 3 (/ O <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# Cie <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> n Name APN 007 - Z2o -_3 FEE DUE <br /> f -�� • %210 EXP:DATE DRIVEWAYS: <br /> Address STREET <br /> �Tc/i/-Tor. C4 cl 20(6AREA QUAD n, c- <br /> City,/Sate-Zip Code TYPE [b p". Gi ivy, <br /> -2-- 2 tc ',:-, 4 FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> D AjZ- C�A,a r- i_L- ilfo <br /> Parcel Owner's Name <br /> CJ• 6 ax. t o4-z- <br /> - Site Address <br /> �e� �.�. DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS 1 <br /> y 1 4 AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL 1 <br /> INDUSTRIAL @ RAV <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Co'''-, ,jC- LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> 4:�T i_i_d-✓L,'-J G ) <br /> Address IThe undersigned hereby applies for permission to encroach on County Highway <br /> C 4 Zi-S- Right-of-Way on the C*J z- side of 2' w e, <br /> City,State Zip Code approximately l ,_ /mile <br /> CI :;1 - Zy A-0 ,by installing Z- <br /> (Area Code)Telephone Pig-,vQ,-- `'`r 'm"- e , <ry iN C, C 1 L <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> TT P'vl 1.11 <br /> Will this project be self-installed? _NO YES Contractor's License A j 2-1 C% �. 2-- <br /> AccessTer ApfformOrivewayPaved frontage <br />