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COUNTY OF SAN JOAQUIN Date' <br /> —, _ <br /> DEPARTMENT OF PUBLIC WORKS Received b �CR# t <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PEP*3M APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> _ Name APN 0&,-, -6�- OZ FEE DUE U. <br /> f-delict z-r EXP.DATE DRIVEWAYS: <br /> Address STREET ,495E GLE/y �D <br /> ft?.�: .TV i'X2 PCsC- Crime% QUA—M--- <br /> City,State-Zip Code TYPE Owv ' <br /> ORRIS �&o n �� <br /> (Area Code)Telephone OTE T— <br /> SITE INFORMATION No Ps <br /> ParcelOwner's Name <br /> 1 - kov't-4 <br /> Site Address DRIVEWAY 4 7V_ [--)od /a�C` C�I 1 �. TYPE QUANTITYWIDTHS <br /> City,State-Zip Code AGRICULTURE <br /> @ FRONTAGE <br /> �C le-[V717 0/4- S-Z/ Z AGRICGRICERCIAL <br /> (Area Code)Telephone COMMINDUSTRIAL @ R/W <br /> 4-/ cg./ SIDENCE —y <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach County highway <br /> Right-of-Way on the .54_ h side of ?ude r are gk& /eco <br /> City,State-Zip Code approximately d,ale feet of !dc,4 W <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 /> AooeasTer App\Form\DrivewayEaved&outage <br />