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COUNTY OF SAN JOAQUIN Date: 8 <br /> r DEPARTMENT OF PI II IC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: D✓?roP <br /> APPLICANT OFFICE USE ONLY <br /> W <br /> Name: ',/e z S �c e \ <br /> Address: a c tr JOB#: 11005 ISSUE DATE: <br /> Cit , State,Zip Code: ,✓� c� APN <br /> 21Z-dS0-oS FEE DUE: <br /> Area Code -Tele one NumberZ -7 -9L EXP. DATE: DRIVEWAYS: _ <br /> STREET: <br /> SITE INFORMATION:tk�_•,as+c,s1 r t AREA: y QUAD t(/ <br /> Parcel Owner's Name: TYPE: <br /> Site Address: Z 352 GcJ K �` /t FORMS: <br /> City,State, Zip Code: �i c�c 2j C� ��,cs ac NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: Q FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: Q RNV <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 Hi h Right-of-Way on the <br /> Sot�.Y side of 1,4A,�+ approximately 990 eA <br /> of iS/r9�LEE ,Qac �,�,y by installing 2) <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? YES NO Contractor's License <br /> Y(FORMS&TEMPLATESlENCROACHMENT PERMIT DRIVEWAY.d.(09/06) <br />