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COUNTY OF SAN JOAQUIN Dater/ 17 /0!- <br /> DEPARTMENT OF PUBLIC WORKS Received by SkIZ, <br /> CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name APN 212 - 106 - 16 FEE DUE '7/0O--w— <br /> EXP.DATE DRIVEWAYS: <br /> c� Addres STREET CLW n'/ eD. • <br /> ¢� �a l S�ep`� 4 �9ce� �y� QUADS + <br /> ( - Ci State-Zip Code TYPE s <br /> 7 FORMS <br /> (Area de)Telephone NOTE <br /> p - -7y5-_d S—CD <br /> SITE INFORMATION <br /> �O�t� e <br /> Site ess t <br /> 3 S �r kd DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY WIDTHS <br /> ea L (zot , pAGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRLAL @ R/W <br /> RESIDENCE <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 side of <br /> City,State-Zip Code approximately 0..30 1 feet/ Nn ` of _e?�,LI <br /> .by installing Ural <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 /> Access\Pcr ApplForm\DrivewayPaved fiwtage <br /> ,1 <br />