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bObZSt� <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: () y o 4 9 <br /> APPLICANT OFFICE USE ONLY <br /> Name: _. <br /> Address tko A JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code:,4 {� 2-2 �= APN p11Z ?00..33 FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: IA9 CQ <br /> SITE INFORMATION: AREA: ,,gV QUAD /VE <br /> Parcel Owner's Name: Ef 4F' TYPE: h/ <br /> SkeAddress: a�;e oep FORMS: <br /> cityS e, Code: c D ' D NOTES: <br /> =Code -Telephotie Number. g 44 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> qt ,Ste,Zip Coder — INDUSTRIAL: _ @ R/W <br /> Area Code -TelephoneNumber: RESIDENCE: / <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby apprkS for permission to excavate,construct and/or otherwise encroach on County Hi way Right-of-Way on the <br /> side o{ /�� �L t�. _`_approximately 50 <br /> Of S Z�, by installing <br /> J0 'he <br /> _Work will <br /> commence on or about _ for approximately days.— <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> WIN this project be self-installed? VYES NO Contractor's License <br /> M9CENTRALSERVICES�CLERICAUPUBSV.WK\MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />