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COUNTY OF SAN JOAQUIN Dater_/2-1 / o <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLIC OFFICE USE ONLY <br /> H U si JOB#11005 ISSUE DATE / / <br /> Name APN - - o FEE DUE f 90 <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET�atSfi QA <br /> (,',. 27f`' r, Z6 AREA -T k A c.Y QUAD SW_ <br /> City,State-Zi Code TYPE `�rJ <br /> k+L e _�L 9 FORMS w P_-1 <br /> Area Code)Telephone NOTE <br /> 5/6- 2 82- 5'5--5-9 <br /> SITE INFORMATION <br /> arcel Ownces Name <br /> S}' Addrre�s <br /> 2 0 ` L9 2 %,,, !Sc R D DRIVEWAY <br /> City State-Zip Code TYPE QUANTTI'Y WIDTHS <br /> A 4-e- G 9. 3 O AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> TRIAL @ R/W <br /> $/O 2 8 RESIDENCE ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> 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 9 Anm side of -PAe AIS►- . <br /> City,State-Zip Code approximately I Qcgo Ad of W` GT <br /> ,by installing <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 /> Awns T-AppTOM1 Dri—yPaved&notage <br />