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COUNTY OF SAN JOAQUIN Date: d_fao�o0 <br /> DEPARTMENT OF NULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES 0-'176Z.qIt <br /> PERMIT APPLICATION CR#: PS—®80 z 3 a4. <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: `"� _ JOB#: 11005 ISSUE DATE: <br /> Cit ,State,Zip Code: n — b APN 05"3 -030 -oqp FEE DUE: <br /> Area Code -Telephone Number: - EXP.DATE: DRIVEWAYS: <br /> STREET: y ' <br /> SITE INFORMATION: AREA: L d1l. QUAD NF <br /> Parcel Owner's Name: ,,- „-e1. - TYPE: ' <br /> Site Address: `7 ; Y ko FORMS: <br /> Citv, State,Zip Code: NOTES: 2-,f- <br /> 2,' <br /> Area Code -Telephone Number: _ �' — <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> '1 `eek_ side of '- F-k IM co approximately 0145 fee mil e� <br /> of r021L by installing <br /> _ Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) i <br /> �( 1 <br /> w� <br /> f <br /> Will this project be self-installed? _ZYES NO Contractor's License U, 3 LWA? <br /> Y:\FORMS d TEMPLATES\ENCROACHMENT PERMIT DRIVEWAY.d.(MOB) <br />