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COUNTY OF SAN JOAQUIN Date: 2--f.s—Zv I[ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: G-- <br /> DRfVE WAYS AND PAVED FRONTAGES <br /> PERW APPLICA71ON CR#: O,��_746 <br /> APPLICANT OFFICE USE ONLY <br /> Name: . <br /> A JOB#: 11 005 ISSUE DATE: <br /> APN S7f-6� -Z FEE DUE: a <br /> Area Cede Le§pNneWurnber _ EXP.DATE: DRIVEWAYS: <br /> STREET: •.' <br /> SITE INFORMATION: AREA <br /> Pard Owners Name: TYPE: !^t vlg— _, <br /> Site Address: 2._ ► FORMS: -S' kX--)) -- <br /> Cede: La Ic WitNOTES: <br /> Area Code -TewmeNaber <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: +� AGRICULTURE: @FRONTAGE <br /> Address: Cgt-� SAI&W # COMMERCIAL: <br /> Ci Std, Code: r-A Z INDUSTRIAL: RNV <br /> Area Code -Telephm Num: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undm*ned hereby applies for peen on to excavate,construct and/or otherwise encroach on County HI way Right-of-Way on the <br /> 94e5r side of Lo[ �2 : iaoxizro approximately Z4242_ <br /> of _dpi ,by installing ,4aZ <br /> Work will <br /> commence on or abut for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> t� U-f <br /> 6 + q <br /> Will flus project,be self ? __,.,,/YES NO Contractor's License <br /> %R WGDVARWSK6nMCEPirRALSERMCESICEEW.ALMM.WK%*IB2 PSt OACWdM PERduNT DRIVEWAY.DOC (IM Page 1 of 2 <br />