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COUNTY OF SAN JOAQUIN Date: / l <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# 3 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name ANN _ �S FEE DUE_ <br /> �� — EXP.DATE DRIVEWAYS: <br /> Addr s STREET " / ,a, e <br /> (2 G°o/ QUAD <br /> City,State-Zip Cod – TYPE Pm-) s <br /> j/ L FORMS <br /> (Area Code) telephone OTE <br /> SITE INFORMATI • >e.s �� a <br /> � � m <br /> e <br /> r Site �dr a <br /> G DRIVEWAY <br /> City, pte-Zip C TYPE QUANTITY WIDTHS <br /> � 2=!10 GRICULTURE @ FRONTAGE <br /> (Area Code)Telepho e I', <br /> OMMERCIAL <br /> �/ INDUSTRIAL @ R/W <br /> '--� / — RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the Wjfj' 6 side of <br /> City,State-Zip Code approximately_ os 95 feet mil sJ4' ,,4hof T_ <br /> by installing <br /> (Area Code)Telephone <br /> will commence on or about for approximately days, Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO _ YES Contractor's License <br /> Access\Per AIVTormOrivewayPaved frontage <br />