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A <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# C> <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN a6--24d - O,} FEE DUE <br /> _ I S LCLA-e EXP.DATE DRIVEWAYS: <br /> Address rSTREET �Y/ST/Al�1> ' <br /> Ste)S-A-' QUAD _ ` <br /> City, ate-Zip Code TYPE <br /> FORMS �S w -17 <br /> (Area Code)Telephone NOTE <br /> - / 53(-a <br /> 1 SITE INFORMATION <br /> i., )[) t+ KLA. <br /> Parcel Owners Name <br /> Site Address DRAIEWAY <br /> ( Ca_vn C) 0-A I TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> RESIDENCE <br /> CO CTOR PAVED FRONTAGE <br /> n t 1,,V%L _ � LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the_ 106S side of <br /> City,State-Zip Code approximately 2 etno elgmile N,+eT/! of <br /> e09..� —by instalffEg <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _NO YES Contractor's License <br /> Access\Per Apff o m\Driveway2aved fimuge <br />