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COUNTY OF SAN JOAQUIN Dater/5/ / 04 7 <br /> DEPARTMENT OF PUBLIC WORKS Received by T; <br /> CR# L' `¢7 1 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICA'T'ION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN-2 S 2, J�.L _ FEE DUE <br /> w.rovk ,IL EXP.DATE DRIVEWAYS: <br /> �—' Address STREET /P%7„L,, /121 <br /> 2 62.9 o 5. S4,A-, Rd --22 QUAD <br /> City,State State-Zip Code TYPE ” <br /> araC4,+ 4S36`( FORMS <br /> (Area Code)Telephone NOTE <br /> ?:c�►–�ov-39 '3 <br /> SITE INFORMATIONS <br /> r k„+, s.ar/ate <br /> Parcel Owner's Name <br /> S. LekM-Qn <br /> Site Address DRIVEWAY GLS -?S30%( TYPE QUANTITY WIDTHS <br /> City, <br /> y,State-ZippCode <br /> `f g'3^w(,1-( AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> @ R/W <br /> RESIDENCE X <br /> CONTRACTOR PAVED FRONTAGE <br /> c.�n✓o�=,f.,C LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> The undersigned hereby applies for permission toe Broach on County Highway <br /> ddress <br /> Right-of-Way on the WeSl- side of 1-e ti M4,1,4w <br /> City,S ate-Zip Code approximately 5*00 �/mile So ,,/6 of LiHne 2a! <br /> by installing <br /> (Area C de)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted.) <br /> ,Vill this project be self-installed? _NO YES Contractor's License <br /> kccessTer Apfforvi\Driveway2ave3 frontage <br />