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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: ` <br /> ,�APPPLICANT OFFICE USE ONLY <br /> Name: l t ,. l,A_ r-- <br /> Address: 9�zS'STZ>f�= r=��G= lz- - JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN ``f FEE DUE: <br /> Area Code -Tele hone Number:- EXP.DATE: DRIVEWAYS: <br /> STREET: lsw_ &z nr Xr- _ <br /> SITE INFORMATION: AREA: 17¢4t- QUAD 5%t. a _ <br /> Parcel Owners Name: 5y <br /> TYPE: <br /> - <br /> Site Address: FORMS: <br /> City,State,Zip Code: ZZ NOTES ,G>�,.- <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> r� <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 undersined hereby applies for permission to excavate,construct andior otherwise encroach on County Highway Right-of-Way on the <br /> L"T� side of Y-)• ?> approximately (re0mile s <br /> Of C�/ETc= l ,2 yr? by installing <br /> commence on or about `?G ' Z for approximately da s. Work will <br /> y <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? -YES X_NO Contractor's License <br /> M:\CENTRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PSIPPICFOACHMENT PERMIT DR)VEWAY.DCC (01108) Page 1 o12 <br />