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COUNTY OF SAN JOAQUIN Date: I 1 <br /> WARTMENT OF PUBLIC WORKS • Received by <br /> D IVEWAY & PAVED FRONTAGES CR# ,g / o / �} <br /> PERMIT APPLICATION <br /> APPLICANT <br /> OFFICE USE ONLY <br /> Name JOB #.11005 _ .. /5 _ ISSUE DATE 1 1_ <br /> 95 2-0 APNJZZ-0- FEE DUE <br /> Address EXP..DATE Z- DRIVEWAYS: <br /> 52C> STREET yes � `� � rh ✓� <br /> City,State-Zip Code AREA w l7� QUAD J <br /> 2s�� 9yfi= y I21 TYPE <br /> (Area Code)Telephone FORMS -3 <br /> SITE INFORMATION <br /> Parcel Owner's ame DRIVEWAY <br /> 1�3�- S • Si. <br /> She Address TYPE QUANTITY WIDTHS <br /> c7�aTCr, �J¢ � AGRICULTURE @ FRONTAGE <br /> City,State-Zip Code COMMERCIAL ti <br /> _C) INDUSTRIAL @ RIW <br /> (Area Code)Telephone RESIDENCE <br /> CONTRACTOR <br /> PAVED FRONTAGE <br /> w v_ <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> ddress <br /> . ")5—Lp\ The undersigned hereby applies for permission to encroach <br /> City,State-Zip Code on County Highway Right-of-Way on the A/oEsT side of <br /> approximately <br /> (Area ode)Telephone 1=` f t/ tle of <br /> ST,C <br /> -'by- installing <br /> Work will commence on or about for approximately days. <br /> ;SKETCH (Separate sheet may be submitted) <br /> .',rill this project be self-installed? NO YES Contractor's License <br />