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COUNTY OF SAN JOAQUIN Date: 6 2oIj <br /> DEPARTMENT OF PULIC WORKS <br /> Received B6�_� — <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: C) (4t v3 l <br /> APPLICANT OFFICE USE ONLY <br /> Name: v 1t%) VS <br /> Address: al 4 AVE , JOB#: 11005 ISSUE DATE: <br /> City,State, Code: e 7 o APN �,l��y%U—l� FEE DUE: <br /> Area Code -Tele one Number: —0 5! EXP.DATE: DRIVEWAYS: _ <br /> STREET: AV ANV -e_ <br /> SITE INFORMATI : AREA: FSC rn, 1p-v,— QUAD <br /> Parcel Owner's Name: vi N.: 2✓, TYPE: Q7�ClV.¢W Gy I <br /> Site Address: Z-1 6 IR 7 c_ 13 A41,6 FORMS: S.SJ Ww k 17 <br /> City,ftte,a Code.- NOTES: <br /> Area Cade -Telephone Numbe,. <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITYi WIDTHS <br /> Nara: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> Code: INDUSTRIAL: _._ @ RIW _ <br /> Area Code -Teh*hone Number. RESIDENCE: <br /> I <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersi ned hereby applies for permission�t.o a�c,a'vate,construct and/or otherwise encroach on Cpun�iw�Right-of-Way on the <br /> ��-side of � E,V6 approximately 'T 1I�Z <br /> of lt1 by installing <br /> Work will <br /> commence on or about for approximately days. <br /> T <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> r <br /> i <br /> Will this project be self-installed? 41yES NO Contractor's License <br /> M.%CENTRALSERVICES1CLERICALIPUB-SV.WK\AMSTER.PSIENCROACHMENTPERMIT DRIVEWAY.DOC (10108) Page 1of2 <br />