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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 6 3 <br /> DRIVEWAY AND PAVED FRONTAGES cc _ <br /> PERMIT APPLICATION <br /> ` <br /> APPLICANT, OFFICE USE ONLY <br /> ) r� JOB# 11005 ISSUE DATE, <br /> Name / ) APN 2 S'7 -'24e.? - <�_ FEE DUE A/�U <br /> EXP.DATE DRIVEWAYS: <br /> Address STREET <br /> Vz- i a n _QUAD E <br /> City,State- p Code TYPE <br /> C'L� C. 't 9 FORMS__ <br /> (Area Code)Telephone NOTE <br /> 771 <br /> SITE INFORMATION NO !�2 <br /> Parcel Owners Name <br /> Site Address <br /> DRIVEWAY <br /> ` City tate-Zip Code TYPE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> IDENCE <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 QUI-h side of t n eaad <br /> City,State-Zip Code approximately C.21 feet ,S of <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 /> AooeaslPer ApfformM)rivewayfaved frontage <br /> i <br /> i <br /> i <br /> 1\, <br />