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i COUNTY OF SAN JOAQUIN <br /> Date: <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# /O <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPQLICANT OFFICE USE ONLY <br /> �L3? JOB# 11005ISSUE DATE <br /> N (� APW67 -020- d� FEE DUE ���2s U <br /> S t f`3to E5! ZI PON EXP.DATE DRIVEWAYS: <br /> � q Address STREET UaJi,n )eo8d <br /> !� ykti—Fe0,Q AREAMGnleca QUAD SG <br /> / C ty,State Zi Code TYPE. <br /> ( U �--Lf� 3(, FORMS <br /> (Area Code)Telephone NOTE <br /> rINFORMATION /l la P��e, <br /> Tb Ny -,-Fi4 <br /> ParcelOwner's Name <br /> L 4 <br /> 1 <br /> MA-An-E- <br /> nA_n� Sitg�Acj�ress DRIVEWAY <br /> /"' Ci ,State-Zip Code TSE QUANTITY WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL @ 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 V/^�_ side of U'l,&I ,vara( <br /> approximately 0.4c> feet/mil So,J� of kS4� icji or, k'd, <br /> City,State-Zip Code til T <br /> by installing n r i'u� <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\Per Apff ormOrivewayPaved frontage <br />