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COUNTY OF SAN JOAQUIN Cate: _ 7-1V-2,o16 <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: a_� <br /> PERMIT APPLICATION �Ob132 CR#: 4 412 4`t <br /> Name: <br /> APPLICANT �] OFFICE USE ONLY <br /> Address: 'CAle- : Su;4e– I f tJOB#: 19005 ISSUE HATE: <br /> City,State,Zip Code: vylrg,, t Gt > ! 33 7 �i APN t –i 4 29 FEE DUE: <br /> f Area Code -Telephone Number ; EXP.DATE: DRIVEWAYS: <br /> STREET: I <br /> L__ SITE WFORNlATION:_ } AREA: ----� <br /> i Parcel Owners Name: LJcc n e_ CGS;1) – – 1 QUAD _.` x <br /> i <br /> TYPE: VV e <br /> Site Address: A r i A D FORMS: <br /> (_City,State,Zp Code: S i'a c k#t3srl (�q �t ( NOTES: <br /> Area Code -Tele phone Number: 5A 4 <br /> DRIVEWAY <br /> CON TRACT OR _ ? TYPE. WIDTHS <br /> 11ANT1TY– - <br /> Name: e c k A. Re-4 kk � _ _ AGRICULTURE: j @FRONTAGE <br /> I Address_ St� er _ v�C "moi _ I z - ' <br /> COMMERCIAL: � ! <br /> F City,State,fp Code: Cts c�S3 3 INDUSTRIAL: �_ ___�____ 1 R _ <br /> ,. Area Code - Telephone Number: ;-L) RESIDENCE: <br /> i <br /> I PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft" <br /> t <br /> The i ned hereby ap lies for permission toe vate,construct and/or otherwise encroach on County Highway " ht-of-Way on the <br /> of �side f. ��� approximately .3Inn <br /> by installing <br /> commence on or about Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> E <br /> i <br /> i <br /> I <br /> , <br /> i <br /> f <br /> I <br /> I <br /> i I <br /> I <br /> Will this project be self4ristalied? YES �NO Contractor's License � � <br /> .L!,tCEh�RAt_SErTJ!CES'CL�RICA�tPV9-S'J:WKIMASt'ER.PS4EFICRCACH,L�!6?PERNG?DP.{'JELVAYAOC (!u:'t5; <br /> Page!,'2 <br />