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Iv. <br />COUNTY OF SAN JOAQUN • <br />DEPARTMENT OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Nam <br />lee C <br />Addre_" <br />City - State - Zip Code <br />Area code - Telephone <br />SITE OWNER <br />� 14 <br />Nalfie <br />,SityState - Zip Code <br />477 -?,7S3 <br />Area. Code - Telephone <br />Area Code - Telephone <br />Fork will commence on or about <br />Date:141 <br />Received 1_ 7 <br />V74 <br />CRV4 1&2 <br />OFFICE USE ONLY <br />JOB H 11005 ISSUE DATE <br />APN 0 FEE DUE <br />EXP. DATE DRIVEWAYS: <br />STREET le -451 <br />AREA 15'1 _QUAD)Vf- <br />TYPE &J <br />FORMS 551WQJ, R-1-7 <br />NOTE <br />DRIVEWAY <br />TYPE - QUANTITY WIDTHS <br />AGRICULTURE 1,5 FRONTAGE <br />COMMERCIAL <br />INDUSTRIAL @ R/W <br />RESIDENCE <br />PAVED FRONTAGE <br />LENGTH: Ft x WIDTH: Ft <br />The undersigned hereby applies for permission to encroach on County <br />Highway Right -of -Way on the side of <br />approximately <br />1Z160 (I j4nke ,:;z5 (j r1A of KI I -la -0e A-) ZD <br />by installing_,P,<Il � -0-1>1 <br />for approximately 0days <br />Fill this project be self -installed? NO YES Contractors -License <br />SKETCH (Separate Sheet may be submitted) <br />---------- T_ <br />ROAD <br />D. <br />lwM.. <br />ROAD <br />DEVAI <br />Fill this project be self -installed? NO YES Contractors -License <br />