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COUNTY OF SAN JOAQUIN Dater/*4',zl— <br /> DRIVEWAY <br /> � 07 <br /> DEPARTMENT OF PUBLIC WORKS Received b <br /> CR# n3z AND PAVED FRONTAGES <br /> PERNUT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN 021 - /16 - �� FEE DUE Y47-90 <br /> t.c`.✓ J,-,-c-zM i 11.E EXP.DATE DRIVEWAYS: <br /> Address STREET Z 19 7X' Or' 4,f <br /> q c;�W s_ A t L".4-t _&i9// --0- QUAD <br /> Ci State-Zip Code TYPE -Z;— <br /> %,I \ + c,A- r).,I L0�1 �� FORMS 5� <br /> (Area Code)Telephone NOTE <br /> 2 � 2 1 C)C <br /> SITE INFORMATION �GS <br /> Parcel Owner's Name <br /> �6e S �sr one- 0(140&J,, 437 Sitw aw Ott� <br /> ' Site Address`— <br /> Ct 6 Li�effu D PRIVEWAY QUANTITY WIDTHS <br /> City State- ip Code AGRICULTURE @ FRONTAGE <br /> �"��'� � �--� 9 S �r3"� ✓ <br /> (Area Code)Telephone COMMERCIALINDUSTRIAL @ R/W <br /> �70 - z:>1 (' . 8' RESIDENCE <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 fh side of L i'b e r <br /> City,State-Zip Code approximately Z o feet 4 of <br /> r 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 AppTormDrivewayPaved frontage <br />