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COUNTY OF SAN JOAQUIN Date: i /l�/6 <br /> DEPART? ENT OF PUBLIC WORKS Received by <br /> CR# Q-a'� 15�— <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNIIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> o JOB# 11005 ISSUE DATE <br /> Name l , �2 APN I 5-7 - ��� 4 FEE DUE <br /> /��U^4c-¢1 ( EXP.DATE DRIVEWAYS: <br /> Address STREET /�i/t/C/t Aue, <br /> Gil 7 S�oGKNen QUAD ZE <br /> City,State-Zip Code TYPE w <br /> FORMS /LTJ <br /> (Area Code)Telephone NOTE —� <br /> SITE ORMATION Vo-z ,Pe, /Z y <br /> `pa c el ?�l/ow �n/ Ode dw AI <br /> Parcel ei's N e 4 !S $i <br /> � . Ate' <br /> Site Addess <br /> DRIVEWAY <br /> Ci ,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE X <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 the We5 f- side of Jae, <br /> City,State-Zip Code approximately bon `e mile lVor�h &S/rrr w Sh <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 AppTorm0 ivewayEaved frontage <br />