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COUNTY OF SAN JOAQUIN Date: P-l U-2©(U <br /> DEPARTMENT OF PULIC WORKS <br /> Received 8y: '/;Z'nJ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERIUNT APPLICATION CR#: 612- (I �( <br /> AP LICANT OFFICE USE ONLY <br /> Name: <br /> Address: ,` ' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN .-Oqo FEE DUE: <br /> Area Code -Telephone Number. - -O t EXP.DATE: —`� DRIVEWAYS: <br /> STREET: e V <br /> SITE INFORMATION: AREA; ye QUAD <br /> Parcel Owner's Name: 0M I N "T L- TYPE: <br /> Site Address: FORMS: 4t t <br /> City,State,Zip Code: A c C 'fit? NOTES: <br /> Area Code -Te one Number <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @RJW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The ned hereby appOps for permss tp excavate,construct and/or otherwise encroach on County H' hway Right-o#-Way on the <br /> S side of _Vt_> approximately <br /> of by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? —X"-YES NO Contractor's License <br /> 1WPWGOV.ORG1sMESICEMMSERVICES1CLERICALM&SV.WIQMZrE.PPS*NCROACHIENTPBWDRNEWAY.DOC (10109) Pap 10f2 <br />