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COUNTY OF SAN JOAQUIN Dater/-a—/p�, <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# ©3tjr_ <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005 ISSUE DATE <br /> Name APN 121_- Igo -_� FEE DUE_Jb IBp <br /> FiKo <br /> S T EXP.DATE DRIVEWAYS: <br /> Address STREET LeeKha�f C;Fr Ad ('is m� QUAD <br /> City,State-Zip Code TYPE pwy FORMS s5/c�x� 12-17Area Code)Telephone OTE <br /> SITE INFORMATION <br /> Parcel Owner's Name <br /> L <br /> Site Address <br /> Fu,,�u Gu uo C RIVEWAY <br /> City,9tafe-Zip Code TYPE QUANTITY WIDTHS <br /> GRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name LENGTH: Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of �a� <br /> City,State-Zip Code approximately_ 1,,3Lr) ad mile_ clo,sy of_' war, /�� <br /> by instal>mg <br /> (Area Code)Telephone <br /> will commence on or aboutfor Work <br /> approximately days. <br /> SKETCH(Separate sheat may be submitted) <br /> Will this project be self-installed? _NO YES Contractor's License <br /> AecemTer App7ormkDrivewayPaved fimmage <br />