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COUNTY OF SAN JOAQUIN Date: y <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: G49G <br /> PERMIT APPLICATION CR#: ,hyla j2�?Z <br /> APPLICANT OFFICE USE ONLY <br /> Address: _ r JOB#: 11005 ISSUE DATE: <br /> Ci ,State,Zi Code APN <br /> Area Code -Telephone Number. ,` e _.- ? 2s 3-220-3S FEE DUE: <br /> y EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION AREA: , QUAD <br /> Parcel Owners Name: �, ,��� - r, .,„a ,,� TYPE: <br /> Site Address -,7, FORMS: S 7 <br /> Ci , State,Z( Code. L - NOTES: <br /> Area Code -Telephone N6mb6r. , <br /> DRIVEWAY <br /> NameCONTRACTOR TYPE: QUANTITY WIDTHS <br /> : <br /> Address: AGRICULTURE. FRONTAGE <br /> COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: 0 RMI <br /> Area Code -Telephone Number: RESIDENCE: <br /> X <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 Hi way Right-of-Way on the <br /> o E side of�'Li��� �,� approximately , <br /> " � by installing yi J <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? _YE;> NO Contractor's License <br /> IISJPWGOV.ORGISHARE)CENTRALSERVICESICLERICALIPUB-SV.WK MISTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10/D9) Page Iof2 <br />