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COUNTY OF SAN JOAQUIN Date: 10 1h,!16 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: j5&—, <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: zwl� ??z _ <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> city,State,Zip Cock APN 24(- f t 0-34 FEE DUE: <br /> Area Code -Telephone NumW. 4; - -73 EXP.DATE: DRIVEWAYS: <br /> STREET: Cf-1-QUIETF aP <br /> SITE INFORMATION: AREA: -7 LAC-i QUAD ! <br /> Parcel Owner's Name: TYPE: �t,J <br /> Site Address: 4 FORMS: <br /> City,State,Zip Code: K NOTES: <br /> Area Code -T Numbe L —- 7h <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: X <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T4e undersigned hereby applies for permission p eitcavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of(( r L TC IAS i< approximately (7'D,2-C e fee mil <br /> Of Kai s->,V- 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 self-installed? YES NO Contractor's License <br /> VMPWGOV.ORGISWEMENTRALSM\ICES\CLERICAL\PUB-SV.WKWASTER.PSIENCROACNMENT PERMR DRIVEWAY.DOC (10109) Page t of 2 <br />