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COUNTY OF SAN JOAQUIN <br />OPARTMENT OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />C Uc CE <br />VLL3Ve GOeC� <br />State - Zip Code <br />(Area Code) Telephone <br />SITE INFORMATION <br />Parceers N me <br />v\C 1� Q <br />nn Site Address <br />City, State - Zip Code <br />4� D -�� 1Z <br />(Area Code) Telephone <br />TOR <br />uc\ C <br />Na e <br />Q C_ l <br />Address <br />City, State - Zip Code <br />L b <br />(Area Code) Telephone <br />Date:/ 2-4 /, 9 <br />• Received by Z-• 'e <br />CR# / d -7 c Z 7— <br />DRIVEWAY <br />TYPE QUANTITY <br />AGRICULTURE <br />COMMERCIAL <br />INDUSTRIAL <br />RESIDENCE <br />WIDTHS I <br />@ FRONTAGE <br />@ RNV, <br />PAVED <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 />t/,/ei-. approximately <br />/�e ee / rxi�e of XArY 8 � __ _ <br />by installing <br />Work Will commence on or about <br />r 3 _ for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />12.20 4C <br />13 ..ROAD <br />VICTL� <br />rpe4 4 <br />.... `"``K" •.14®'>t. CH.oAR ,me.se<o <br />- <br />x,150 z<c <br />V 11. <br />CIS <br />xi r® N <br />Will this project be self -installed? NO <br />YES Contractor's License <br />