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COUNTY OF SAN JOAQUIN Date: "( l fi� l oe <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CRS L� 53 40 15 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN /32 -per__ OZ FEE DUE <br /> e-CC,s EXP.DATE DRIVEWAYS: <br /> Address STREET_�/� RQ/ <br /> 7 3 L N e e r Yt—aAREASeo G!Grn QUAD _ <br /> City,State-Zip Code TYPE <br /> C.✓� SZc S FORMS <br /> (Area Code)Telephone NOTE <br /> C7uS� �4 �i - SSZ3 <br /> SITE INFORMATION e's 0th e <br /> ►9A1,_ L"�,k (Q . <br /> / <br /> Parcel Owner's Name <br /> 3 1- 3 nJ-e w - -.. 1'L <br /> Site Address <br /> S C w 5 a zo r DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> I.I - 6 L z L AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL bs`. <br /> INDUSTRIAL @ RJW <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned herebyapplies for permission to e�ncffoach n County Highway <br /> Right-of-Way on the it S Y4- side of /V eW <br /> City,State-Zip Code approximately 6, 4 s feet mile /V c,y{� of _ �( <br /> by installing <br /> (Area Code)Telephone <br /> will commence on or about for approximately days. Work <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Access\Per AppTormOrivewayPaved frontage <br />