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COUNTY OF SAN JOAQUIN Date: a 1d3 /CO <br /> DEPARTivIENT OF PUBLIC WORKS Remved by Se' <br /> CRli nagfgz <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Zr Y-,c. Ya W t' JOB N 11005 ISSUE DATE <br /> Neme N�3 - - o FEE DUE t�I7- <br /> i�2 u p�2.1AiL acl'� EXP.DATE DRIVEWAYS: <br /> A � STREET S. El- DoRudn Sr • <br /> QUAD St • <br /> City,State-Zip Code TYPE QA,4W • <br /> ORMS SS w_ , -17 <br /> (i-m Code)Telephone OTE <br /> SITE INFORMATION <br /> U - <br /> ParoelOwnces�r sme ' <br /> 77ii 5 Lt)/r4.0V <br /> S' Addre. (A R vfEWAY <br /> City State-Zip TYPE QUANTITY. WIDTHS <br /> O GRICULTL ®FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> FUSENCE <br /> TRIAL ®R/W <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIL Ft. X WIDIU- Ft. <br /> Nsmc <br /> Address The undersigned hereby applies for permission to encroach on County Highwzy <br /> Right-of-Way on the. W£51 side of S. f1 Qe)A41 Jb sz: <br /> City,State-Zip Code approAmately mile ipw.5007)'t of Coudr _ <br /> -1¢,SP;Ti-f 0, by' I.IUJ <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for apprmdmately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Ao-u\Par App\FormZdvawayEawed fia tap <br />