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r ," COUNTY OF SAN JOAQUIN Date:/( <br /> DEPARTMENT OF PUBLIC WORKS Received byCR# 3C 8 Rg- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DA <br /> /� Name APN�-'¢Zd - �i FEE DUE /�D,040I �f-H c,"C., EXP.DATE DRIVEWAYS: <br /> „Address STREET_W1 <br /> AREAG'�� QUAD N 5 <br /> City,State-Zip Code TYPE 01 <br /> G E. FORMS 53 <br /> (Area Code)Telephone NOTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> Site Address <br /> - /A t),—,,- <br /> , DRIVEWAY <br /> City,State-Zip Cade TYPE QUANTITY WIDTHS <br /> S eo c 4. C k, '9 53Q -/ AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> dei `1 SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on unty Highway <br /> Right-of-Way on the�b r- side of /0w21 <br /> r Ak". <br /> City,State-Zip Code approximately a /mile 6C,a f- of ,s As U r. <br /> by instal hng bw <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 /> Accew\Per App\Fam\DnvewayPaved frontage <br />