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COUNTY OF SAN JOAQUIN <br /> dby_ � <br /> DEPARTME :2e+:eiveb <br /> NT OF PUBLIC WORKS _d EES f p <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> � �}cl► �.f o� JOB#11005 ISSUE:DA <br /> Name APN 9, .Q3� 4$ FEE DUE O. ZX� <br /> ?, Z .DATE DRI�BWAYS: <br /> w s STREET '- LEELE12 <br /> /vJ r� S O F—Al�/�t QUA—42—F--- <br /> City,State-Zip Code TYPE <br /> FORMS �, R/7 <br /> (Area Code)Telephone OTE <br /> No LEE <br /> SITE INFORMATION <br /> c cL <br /> Pa=l Odwes Nemy <br /> �J Si ddress DRIVEWAY <br /> <+� Zy TYPE QUANTITY. WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRL4LL @ R/W <br /> ENCE ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIE Ft. X WIDTH It <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of Jez, <br /> City,State-Zip Code approximately,c ,3C.+r,,�j mile Ae&,4?ro 1 of Zo <br /> •by installing Dt t7 <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 /> Aoo—Ter ApplFormW6ve—yPaved f wta®r, <br />