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COUNTY OF SAN JOAQUIN Date: 10 / I /Z <br /> DEPARTMENT OF PUBLIC WORKS Received by 6LJn,•—/:t.`z.__ <br /> CR# 6 K35'z r 7 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN2S5 - 65-o- -3 FEE DUE <br /> ) Imo-- ,5_ �n )-�Lr EXP.DATE DRIVEWAYS: <br /> Address �q STREET <br /> LZL( 1 C_�i QUAD rife <br /> nCity State-Zip Code T L`OTERMS <br /> YE Lf� <br /> O ,lJ Z-/7 <br /> (Are�elephone <br /> SITE INFORMATION NO /01/�2d <br /> Parcel Owner's Name <br /> GS't kddress <br /> 1'©gyp DRIVEWAY <br /> City,State-Zip Code �— TYPE QUANTITY WIDTHS <br /> CjN�-) - AGRICULTURE @ FRONTAGE <br /> (Are Code)TelephonL e COM1vIERCI4LL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <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 6&A side of uk & f _.,e" 1.a! <br /> City,State-Zip Code approximately / feet mile of <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 AppTorm\DrivewayPaved frontage <br />