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COUNTY OF SAN JOAQUIN Date: 10 /-1— <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# O3 - <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERIVIIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> )"or <br /> )Ga,Y\ JOB# 11005 ISSUE FEE DUE TE <br /> Name APN0_0 -J o-—� <br /> EXP.DATE DRIVEWAYS: <br /> Address _ STREET aft /Ili. <br /> 1-'j QUA tJeF <br /> _ <br /> City,State-Zig Code TYPE PLV <br /> c.�) ( i{ .`jc FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION 1 /01 <br /> Parcel er's Name <br /> Site Address_ DRIVEWAY <br /> r ,State-Zi Code TYPE QUANTITY WIDTHS <br /> t6c7� I q j•7 9-7 AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACT¢R PAVEDFRONTAGE <br /> vv E�'�v v� ( %� 1� LENGTH: Ft. X WIDTH: Ft. <br /> Addre The undersigned hereby applies for permission to encroach on County Highway <br /> i�,e�5z[DC,t- &i,, Right-of-Way on the 645eof Cgrr91 i 1;a4 L <br /> City,State-Zip Code approximately / feet mile S' !�i of t_ah",4/Zes <br /> ( G Z ,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 /> AcemsTer App`FormlDrivewayPaved fi=tage <br />