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COUN,Y OF SAN JOAQUiIN Daze.- <br /> DEPART MENIT OF PIULi'C WORKS <br /> DRIVEWAYS AND PAVED <br /> D FpnNTAGES <br /> PERMIT APPLICATION CRS_ <br /> APPLICANT USE ONLY <br /> Name: <br /> — <br /> Name: OK a rxL -- <br /> Address: 2,3 lc� E�rrt ,5y• (y , JOSE: 11,005 <br /> :SSvt DATE- <br /> City,State. Code: APN v _ [}-o EE`CUE: <br /> Area Code -Telephone Number ,lj9 GS-Glr/8 l i EXP.DATE: - 6-2D1 j DRIVEWAYS: _ <br /> STREET: e s-t- t e 1r• _ <br /> _ AREA: <br /> SIT`C iNFCRN.A.TION: n A - - -----____ _-- <br /> : <br /> 1 -Par-cel Cwnees Name: i• 41-11 ce4f S TYPE: t u eubc,�tv� �---- - --' <br /> Site AddreSS: 33 e7l FORMS: JtA <br /> .State,Zip Cade: OG d� �/2. i NOTES: S82 C•-���G -��r��„J vs <br /> Area Code -Telephone Number: <br /> DRIVEWAY i <br /> i CONTRACTORS j TYPE' uUA^,TIIY - --- 4'�iCTH <br /> Name: S ! AGRICULTURE: I --TWPGN T AGE <br /> Address:, . __ i COMMERCIAL i — - <br /> �_— <br /> CityStateZip Code: 3 <br /> 1 al �4 : INDUSTRIAL: <br /> A - --- }- -T ----- -- ------�-t°----- -- <br /> Nr a ,ode - I T elephone Number: j RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTil' Ft X V:'iCTR' ----- - --- <br /> �t <br /> �����d��signed hereby aps Tor permission toe vate;canstn:�and.�ar ati?envise encroach cn Cauaty R' a v,ay R„; o:-lray an;ne <br /> 161�Z. -�rd�e_of�-�r-V 1e t.. �Ir -_arr3prox:mately_ �i_ ie Jmile'�� 'fc1J�j <br /> commence on or about -Tor approximately _ days. -- <br /> 1 SKETCH(Separate sheet may be submitted; — - -- <br /> i <br /> i <br /> i <br /> 1 <br /> 1 <br /> 1 <br /> l <br /> 1 <br /> 1 <br /> i <br /> i <br /> l <br /> W'!l this project be self-installed? YES NO Contractor's License <br /> VtC�ti'i P,1LS=.RJtCE'J'CLE'r.ICAC'?L'S-S'i.NI'.dJ:3TER.?S1EPiCRO:.Cn'NEh:Pc°bFT DF.I'VBVAYWC (11'v5) Page 1'i2 <br />