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COUNTY OF SAN JOAQUIN Date: g"2-4-2.oa`r <br /> DEPARTMENT OF PULIC WORKS <br /> Received By.- <br /> DRIVEWAYS <br /> y:DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:6S 6311 <br /> APPLICANT OFFICE USE ONLY <br /> Name: 0 vti t <br /> Address JOB#: 11005 ISSUE DATE: <br /> City,State, e: C„ APN 10 1 C51 FEE DUE: <br /> Area Code -Telephone Number: Zz�, q Ir"— I EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: ,,, QUAp <br /> Parcel Owner's Name: =Z— TYPE: <br /> Site Address: � Gt C,.'j"--"' FORMS: <br /> City,State,Zio Code: �" L NOTES: <br /> 3 <br /> Area Code -Tel hone Number: - o <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 -Tele hone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: R. X WIDTH: FL <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County H' hway Right-of on the <br /> -Way <br /> So side of . <br /> approximately Sx fe i!e <br /> Of by installing <br /> Work will <br /> commence on or about for approximately days, <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? ES NO Contractor's License <br /> Y:V-0RW d TEW ATESEN0F"CHWNT PERMIT DRIVEWAY.d.(06708) <br />