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COUNTY OF SAN JOAQUIN Date: �2 / Q l 2co7 <br /> DEPARTMENT OF PUBLIC WORKS Received by_T�3 <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> � qq APPLICANT OFFICE USE ONLY <br /> yvt Y i "J 6�_ / 4- JOB# 11005 ISSUE DATE <br /> Name APN lqf C 4n - O q FEE DUE <br /> 2.3 Ci t4 . - -1<4-C-) _Sj EXP.DATE DRIVEWAYS: <br /> Address _ STREET w/ W 7/en <br /> S i cc.lc 4 6-'V' CA , S1VcZefanQUAD .5 <br /> City,State-Zip Code TYPE ,2w; <br /> Cl 5 L — 7-,3 7 �L FORMS Ss / <br /> (Area Code)Telephone NOTE <br /> No 0* Pyuired GulAir► w o <br /> SITE INFORMATION t <br /> ill ti 1y i '=JL�.i i t~�Ot 1A �oelfr /atcd art-,w �rr� �r.► 'y"4.4 �: �eeo�.erew by �i,vr <br /> Parcel Owner's Name <br /> Site Address <br /> , +GL. <A C A U ic) DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone !-L COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> � i LENGTH: Ft. X WIDTH: Ft. <br /> —Name <br /> Address The undersigned hereby ap lies for permission to encroach on County Highway <br /> Right-of-Way on the 9sf' side of Wil&a <br /> City,State-Zip Code approximately feet mil AVO r 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 /> ���(s) �014lec/ beyond <br /> n� rrl9 a�isrr �/�AcG/ <br /> n, <br /> Will this project be self-installed? —NO YES Contractor's License <br /> AccessTer AppTormlDrivewayPaved frontage <br />