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COUNTY OF SAN JOAQUIN Date: ?-(/ -2D b <br /> DEPARTMENT OF PUtIC WORKS <br /> Received 134 )C_7 <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION � CR#: Oy I �Z , <br /> APPLICANT ( OFFICE USE ONLY <br /> Name: 1A IRA A <br /> Address: owl h JOB# 11005 ISSUE DATE: <br /> City, ate,Zip Code: (, APN (p -(��_ I FEE DUE: <br /> Area Code -Telephone Number. 1P 9— EXP.DATE: DRIVEWAYS: <br /> STREET: . b A J`e <br /> SITE INFORMATION: AREA: S Kfiv w. QUAD <br /> Parcel Owners Name: TYPE: <br /> Site Address: FORMS: S f(y I <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: R/y/ <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 Highway Ri�jit of-Way on the <br /> o5A side of (F'C�`�#DyL cre approximately /A> feet/*Re 6 �_ <br /> of AL)A f�v�, by installing <br /> Work will <br /> commence on orabout for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> MiCENTRALSERVICE=LERICALNUB-SV.WK%%STER.PS4ENCROACHMENT PERMIT DRNEWAY.DOC (10100) Paget oft <br />