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COUNTY OF SAN JOAQUIN Date:5 Z/4f /Zc> <br /> DEPARTMENT OF PUBLIC WORKS Received by �— <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name } APN Z.0 l ¢ FEE DUE <br /> D I EXP.DATE DRIVEWAYS: <br /> Address-, STREET <br /> 2(1 J ��:f�C I r) C AREA �lgA)I tQ c rt. QUAD sC- <br /> S,City,Stat, -Zip t,�d <br /> TYPE <br /> C i FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION A10 10� <br /> Parce.Owue(s Name <br /> 1 Site Address <br /> L)C,24 H6--oj5 RE(d DRIVEWAY <br /> C ,S�to-ZCode TYPE QUANTITY WIDTHS <br /> IylCntC(Cy 'A P11 <br /> ,-j f- AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> 2.C;Cj . �-�1 ZC i L �� <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> tai N,I a r Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the S1- side of /-ams % jwo <br /> approximately O 4U feet/ Saud of All C"A,i//h <br /> -� City,State-Zip Code 1 <br /> 12d,/J ���.�/i'�l' , -by installing <br /> (Area Code)Telephone <br /> 'z.G c( I 5 <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 Apff orm\DrivewayFaved frontage <br />