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COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORKS ::ecciveJ by <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> / <br /> -APJOB <br /> OFFICE USE ONLY <br /> ISSUEDATE0 <br /> ✓�" 70B#11005 30 - ZZ FEE DUE <br /> --Nam ,/ APN EO - <br /> (� fI I/-I l'• r h-e fEXP.DATE DRIVEWAYS: <br /> STREET �!�✓DEJ ` <br /> J b ss L�S,7�j' QUADAREA <br /> City,State-Zi ���^ TYPE W ` <br /> v\ a.0ORMS S kl(Al, -l7 <br /> ( Code)Telephone <br /> aG 721i <br /> SITE INFORMATION <br /> Par;l s N <br /> �J Site A ss ) DRIVEWAY <br /> C d.✓0 TYPE QUANTITY WIDTHS <br /> City,State-Zip I S AGRICULTURE @ FRONTAGE <br /> Area Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> PAVED FRONTAGE <br /> (,(.✓Y1 �� (� LENGTH: Ft. X WIDTH:_ Ft. <br /> Name <br /> Address The undersigned hereby a 'es for permission to encroach on County Highway <br /> Right-of-Way on the MoRrAl side of aA1,90eJ_,A0_&V jet <br /> City,State-Zip Code approximately do l mile /� — of $14 GIG- EF- <br /> City, <br /> ,by installing h (d/ <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 /> AcemTer App\Form\DrivewayPaved ftootage <br /> • <br />