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COUNTY OF SAN JOAQUIN Date: J�, / 17 /-�-s <br /> DEPARTNffiNT OF PUBLIC WORKS Received by G� ` <br /> CRS -'SS!F G t H -- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB n 11005 ISSUE DATE <br /> Name APNO _- Z�Q- FEE DUE <br /> C< C EXP.DATE DRIVEWAYS: <br /> Address STREET HIC&P 6tnde <br /> GdZ 2 Lodi QUADN V1 <br /> _ <br /> City,State-Zip Code TYPE <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION yes <br /> Parcel Owner's Name <br /> Site A�S ss DRIVEWAY� <br /> T� City,State-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> @ 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,We4 f side of a ro de /2d <br /> City,State-Zip Code approximately D. S 7 feet mil AJOY -h Of <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 /> s E- 4--t-54C/46b . <br /> Will this project be self-installed? NO YES Contractor's License <br /> AccessTer AppTorm\.DrivewayPaved frontage <br />