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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN 250 - /00 FEE DUE <br /> `�1 1✓ln/� I I C e-t/y SC V2-,.k-r(0,1) EXP.DATE DRIVEWAYS: <br /> r Address STREET &i d ,ed <br /> `2-4I ?c C AT AREA 77-a<U QUAD SGy <br /> 1 City,State-Zip Code ,{ TYPE <br /> A(-L t-) CA ��) �I'� "L S FORMS <br /> _ (Area Code Telephone NOTE <br /> ro Dvsc� <br /> SITE INFORMATION Ivo ,O/�G t�f�tre`d �'�� <br /> Parcel Owners Name Ori <br /> 2-3 7S S. T3i421) . <br /> Site Address DRIVEWAY <br /> 6A TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/vv <br /> 0•L; t:N L, C N,-j co f% l I.k t�1 RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> A_S Aa` :-f Q 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_N/iSZ- side of && Rc/ <br /> City,State Zip Code approximately 9W ee /mile ydufGi of —&/eur <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 /> AccessTer Apff orm\DrivewayPaved frac t ge <br />