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R COUNTY OF SAN JOAQUIN Date: S / Z /og <br /> DEPARTIENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name ] APNI L/5' -240- z27 FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> r f A ess STREET <br /> n t 1 r *�/ f�IJ QUAD /C/L <br /> City,State- Code TYPE 7�e.J <br /> M S'2_Z-C) FORMS i2/7, 5� /mil,✓ <br /> (AFa Code)Telephone NOTE <br /> �n _ 2)- 7- &, ? S- <br /> SITE INFORMATION <br /> 'G el C t s ame <br /> 1 L S Address / DRIVEWAY <br /> City,State- tp Code TYPE QUANTITY WIDTHS <br /> 7 SZZ-0 AGRICULTURE @ FRONTAGE <br /> (Ar6a Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <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 A,1or oi$o-wF ig, $•,�d, ee`'jpf_ 12,p <br /> City,State-Zip Code approximately / .-(fee)/mile Ems of Lenge C,r,4.- Roar( <br /> 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 /> AocessTer AppTormOrivewayPaved frontage <br />