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s <br />APPLICANT <br />C,JUNTY OF SAN JOAQUIN <br />SPARTMENT OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT E B A'r1 '"' <br />Name <br />o 0 3 G..� � ��s •2� <br />Address <br />JT <br />ity, State - Zip Code <br />-40%— 9-3 S S'S� 9z <br />(Area Code) Telephone <br />SITE INFORMATION <br />Parcel Owners Name <br />Site Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />R <br />Name <br />Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />Date:/ 2- <br />Received by <br />CR# /Q 7 SGS 2 <br />DRIVEWAY <br />TYPE QUANTITY <br />AGRICULTURE <br />COMMERCIAL <br />INDUSTRIAL <br />RESIDENCE <br />WIDTHS I <br />@ FRONTAGE <br />@ RNV <br />PAVED FRONTAGE <br />LENGTH: Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to encroach <br />on County Highway Right -of -Way on the i-ifj; side of <br />c'j approximately <br />oa=` feet mile 5,o W-// of <br />T,Ae!:ig-c -i, by installing �.�i/'4: <br />work will commence on or about �. % Ski for approximately / 6`6 days. <br />SKETCH (Separate sheet may be submitted) <br />„" <br />® i <br />B <br />f <br />Will this project be self -installed? NO YES contractors License <br />