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2- <br /> COUNTY OF SAN JOAQUiN Dare: 2c>16 <br /> DEPARTMENT OF P►ILIC WORKS <br /> ReCeived B4: 6 -,)L-z <br /> DRIVEWAYS AND PAVED FRONTAGES ®- <br /> PERMIT APPLICATION <br /> APPL <br /> rPL rCA"J i i i 0FF1 CE VSE C'NLY <br /> Name: (,tf► ice_ .+ S 0.h ) t D+n n ! i <br /> Address: TV9±kAW j JOB#: ? CCS ISSUE DINE' <br /> Ci'y,State,Zip Code: d a a j APry 01 - FEE DUE: <br /> Area Code -Tele bona Numberl (Ze-1) 333-Co o ; ! EXP.DATE: DRIVEWAYS: ! <br /> j ! STREET. r _-- <br /> 1 SITE iNFORMAMON: j AREA: Q QUAD - — <br /> ! Parcel Owner's name:JAJ 11tipm + T YPEC� <br /> ,AeAddress: .2,,a3S-3 K . t v-4j4-,-eWo- FdP-I FORMS: <br /> State,7ig Code: JN cA c , } za i ! COTES: <br /> Area Code -Tete one Number: to-y -.6 1 0 — <br /> i DRIVE VAY <br /> CONTRACTOR —! i TYPE: QUANTITY W, DTHS <br /> Name: Q 6 oJ,e_ ! ; AGRICULTURE: ! I aFRONTAGE <br /> Address: _ _ i <br /> � GOM�fERCiAL: <br /> City,State Zip Code: — i INDUSTRIAL: <br /> Area Code -Telephone Number: — --� ; RESIDENCE: ! - r ---- <br /> PAVED FRONTAGE <br /> LENG T i ist. X WIDTH: — t. <br /> The undersined hereby applies for permission to excavate,constrict and/or otherwise encroach or <br /> County }way Right-of-Wayhe <br /> e �Y--e -klawe_!4 IZA• approximately .SSU t feed <br /> of _--__—_-, _—,by installing <br /> commence on or about for approximately_ ,days. <br /> SKETCH(Separate sheet may be submitted; <br /> ! <br /> j ! <br /> 1 <br /> ! <br /> i <br /> r <br /> i <br /> ! <br /> i <br /> i <br /> Will this project be self-installed? X YES NO Contractor's License <br /> Lt.+.Ci SERiI!CE3',CLEFiCAIV'U4-SV:Jv'K'.RJw^TER.PS1�'iiC�OACrih !T PEP..LST�RfJEtiYRY.60C (tu.'O5j Page 7:i2 <br />