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e/ / 06 <br /> COUNTY Y OF SAN JOAQUIN Date:Received by _ <br /> DEPARTMENT OF PUBLIC WORKS <br /> CRO <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> ooL t JOB#'1.�10�05 ISSUE DATE <br /> Name N -,240 _40929- FEE DUE <br /> C� 4- EL jNA L IVK. 1=DATE DRIVEWAYS: <br /> Address STREET <br /> STaG w-m#( , GA. Zo 5 QUAD ,5 <br /> E:�;�City, tate-Zip Code TSE <br /> �Area ORMS Code)Telephone OTE <br /> SITE INFORMATION <br /> Parcel Owners Name <br /> S'lb�lgyN UNi��O �-•�ot�l 17iS i <br /> Site Address DRIVEWAY <br /> ( (0'7 S WAG 1,167A►V E• TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE Q FRONTAGE <br /> r�'OGiG COMMERCIAL <br /> (Acca Code)Telephone FINDUS <br /> TRIAL @ R/W <br /> ,� US€ acBvJ� Qt'4a��` ►Juw� ti2 <br /> t40 �SIDENCS T6M P A KivEWA iz Bvs 6 iZ' 1JL` <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH:-_Ft. <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Highway <br /> Address Right-of-Way on the side of <br /> approximately feet/mile of <br /> City,State-Zip Code by ung <br /> (Area Code)Telephone <br /> Work <br /> will commence an or about -O for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> ��., To a�pea��v off-s�� ve�t�ty P�-�fi P�.«,�►s <br /> Will this project be self-installed? NO YES Contractor's License 0/e, 5tkla►tl- Oi Ti WG'C� <br /> A—Ter AppTbrmVxivewayEavad froatage <br />