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COUNTY OF SAN JOAQUIN Date: <br /> -. — DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: srvwerz— <br /> Address: r-201-7 Svi r= JOB#: 11005 ISSUE DATE: <br /> CRY,Stale,ZIP Code.. dZo yr u E C?} 7g--&-78 APN 1-73-Dl d-2 Z FEE DUE: <br /> Area Code -T` Number: %1(0 - 7 0•?S—6fi EXP.DATE: DRIVEWAYS: <br /> STREET: ^Ywrk 10101 ,41,16. <br /> SITE INFORMATION: AREA: 5-?-Aee-r,0A1 QUAD �S <br /> Parcel Owner's Name: TYPE: w <br /> Sipe Ad ss: 3(P S FORMS: 96V <br /> SWA zip Code: . STV rc tv,�-� L'. 5- S- NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> CAy,Stale,Zip Code: INDUSTRIAL: @R/W <br /> Area Code -TeW=e Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for fission to ex ate,construct and/or otherwise a ch on County ay Right-of-Wa on the <br /> x,145 7" side of �aE � ✓� approximately <br /> of Fig am)KYWM N 9D� by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be seftstalled? YES NO Contractor's License <br /> 1\& WGOV.ORE&WtESICEMTMSBMCESVCUR AI.IPUB&WKWIASTM P MAT DRNEWAY.DOC (1009) Page 1 of 2 <br />