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COUNTY OF SAN JOAQUIN Date:Receiv <br /> ed by 1?3 1 dP r8 <br /> _ <br /> DEPARTMENT OF PUBLIC WORKS CR# O 3 So 7 9 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> P RMIT APPLICATION <br /> nr TCA OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> N __�� FEE DUE <br /> � LI <br /> �G� AllIr <br /> ��y'�!''i4,Cj LXP.DATE DRIVEWAYS: <br /> Ad ess STREETAREA Gldtt���1 <br /> QUAD_7c/ s <br /> City State-Zip Code TYPE t) <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFO ` <br /> Parcel Owner's Name + <br /> Site Address DRIVEWAY <br /> "T <br /> C— '> <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> ?_�I©J COMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> RESIDENCE <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 side of jr uJ� , c}1 •. <br /> approximately /00 feet/Ke � of � 1 <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 /> AccessTer AppTorm\DrivewayPaved frontage <br />