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COUNTY OF SAN JOAQUIN Date:03 /L/ Zoo li� <br /> DEPARTIVENT OF PUBLIC WORKS Received by <br /> CR# C).3 LJ <br /> DRIVEWAY AND PAVED FRONTAGES es-o$0 l b y-s- <br /> PERMIT <br /> SPERMIT APPLICATION <br /> PLICANT OFFICE USE ONLY <br /> � . PrLP JOB# 11005 ISSUE DATE l I <br /> —�T -�d-0_ FEE DUE <br /> gyp.D TE DRIVEWAYS: <br /> ! ddress �i STREET toil` QUAD �u <br /> I % fid 5 2Zd <br /> ity St a e-Zip C�° TYPE ` <br /> 9FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFOR14ATTON <br /> 1 /� � e <br /> Parcel Own is Name i f7PCor� +.�� !Jr' f r� <br /> `i/ Jra� Zz r <br /> Site Addres�,,,®7' DRIVEWAY <br /> TYPE QUANTITY WIDTHS <br /> State' <br /> tate-Zip Code AGRICULTURE @ FRONTAGE <br /> 9-Zip <br /> COMMERCIAL <br /> Code)Telephone INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVEDFRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned heretinst <br /> NVI'Ll ssion to encroach on County Hi�hway <br /> Right-of-Way on th de of //7 <br /> City,State-Zip Code approximately 0 i of 51Xr1/ 5� <br /> , <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 App\Form\Driveway?aved frontage <br />