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COUNTY OF SAN JOAQUIN Date:12 / /Z�7 <br /> DEPARTMENT OF PUBLIC WORKS Received by — <br /> CR# C '5� n ' c' - <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE ! / <br /> Name APN M - FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> �� Address STREET <br /> 19 (� iPC1A <br /> 1 G'iN �i� I gLA. A _Z Inch D QUA <br /> City,State-Zip Code TYPE <br /> /gwrlrCA 11 ,/47 3 FORMS <br /> (Area Code)Telephone OTE <br /> SITE INFORMATION /vD <br /> Parcel Owner's Name <br /> 9f4xut <br /> _ Site A,r ess DRIVEWAY <br /> /l e J ,� f/$J< J� TYPE QUANTITY WIDTHS <br /> City,State-Zi Code AGRICULTURE @ FRONTAGE <br /> -2474,v 11 _4 ,� S 3 3 CONOM7-RCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W— <br /> RESIDENCE <br /> �3D - 2f'/ -Z--DQ'7 <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 on the OY side of ,AJ51c, 20Z� <br /> approximately 760 mile of it rf y <br /> City,State-Zip Code ,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 /> Aaess\Per AppTorm\DrivewayPaved frontage _ <br />