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COUNTY OF SAN JOAQUIN Date-!a6/0 / I <br /> DEPARTMENTReceived by OF PUBLIC WORKS CR# 0 Q-q <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Me-Lest re JOB#11005 � � ISSUE DATE <br /> Name N W57- 17 <br /> - FEE DUE <br /> i;. Q 10 i-inaafn W v EXP.DATE DRIVEWAYS: <br /> Address STREET i 07-Y �a <br /> C1� (f a5�32 QUAD A-,V <br /> City,State-Zip Code TYPE �etiJ <br /> Zit- ab°l --Ao7S FORMS <br /> (Area Code)Telephone NOTE I Of <br /> SITE INFORMATION <br /> t Parcel Owner's Name <br /> �a 6o E. 146e.A,. Ro�. <br /> Site Addres <br /> ADRIVEWAY <br /> S6*�2 <br /> Ci�yZTYPE QUANTITY WIDTHS <br /> State- ip Code <br /> State Zip @ FRONTAGE <br /> 70 3 O <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> IRE S <br /> CONTRACTOR PAVED FRONTAGE <br /> SAOL-a `cam LENGTH: Ft. X WIDTH: Ft. <br /> Nalne <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the --9Scerrw side of L/.8MOry ", <br /> City,State-Zip Code approximately lzm o grAtrr of NlCX <br /> a'tea. ,by installing 2t2l&2 <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 /> A—Ter ApplFamlDrivewayPaved fiatage <br />