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COUNTY OF SAN JOAQUIN Date: /� �o <br /> DEPARTMENT OF PULIC WORKS _ <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#:� l� <br /> APPLICANT OFFICE USE ONLY <br /> Name: ;f' --P <br /> Address: C) o 16y 1/ (4) 11-,g 0 JOB#; 11005 ISSUE DATE: <br /> Ci ,State,Zi Code: , / - Aq, 1 (10 APN FEE DUE: <br /> Area Code -Telephone be ) EXP.DATE: DRIVEWAYS: <br /> STREET: A <br /> SITE INFORMATION: AREA f QUAD <br /> Parcel Owner's Name: I TYPE: <br /> Site Address: a �, FORMS: y,/ <br /> Ci ,State,Zi Code: r-.N� � A. NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Address: <br /> Name: AGRICULTURE: FRONTAGE <br /> Ci COMMERCIAL:,State,Zip Code: INDUSTRIAL: R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to z-5! '� excavate,construct and/or otherwise encroach on County ;g y Right- f-Waon the <br /> side of_2��¢ 4�A) jam, approximately_� o y <br /> f <br /> of �17�L, >L'D by installing <br /> commence on or about Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARES(CENTRALSERVICESICLERICALIPU&SV.WKIMASTER.PSEENCROACHMENT PERMIT DRNEWAY.DOC (10109) Page 1 oft <br />