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COUr`' F SAN JOAQUIN <br />OEPARTML. OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />�,Q9N� C ��crJ Cx=�9 ciG <br />NaryryS� <br />Addre <br />C� <br />City, State - Zip Code <br />(Area Code) Telephone <br />Parcel Ownerg Name <br />Site Addres <br />� 7 C <br />City, State - Zip Code <br />4122 — 02 -0 e, <br />(Area Code) Telephone <br />NTRAC <br />C, <br />Name <br />Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />Date: <br />• / <br />Received by <br />CR#,1B"7 <br />DRIVEWAY <br />TYPE QUANTITY WIDTHS <br />AGRICULTURE @ 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 <br />on County Highway Right -of -Way on the side of <br />/' `'' ST approximately <br />560t fe t rw+le Ald-A!;54 of �S�o L•'� <br />, by installing <br />Work will commence on or about <br />rate sheet may be submitted) <br />for approximately // X U days. <br />Will this project be self -installed? NO YES Contractor's License <br />