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_ COUNTY OF SAN JOAQUIN S' 4C,0?,t�b Date: i a <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAYED FRONTAGES <br /> PERMIT APPLICATION CR#: U'`- Z= <br /> APPLJCANTt OFFICE USE ONLY <br /> Name. -e ' <br /> Address: JOB#: 11005 ISSUE DATE.- <br /> City,State. <br /> ATE:Ci ,Staff,7� Code: APNt� C :-21_ FEE DUE: <br /> Area Cade -T Dumber. EXP.DATE: DRIVEWAYS: <br /> STREET: (+ kv t. A Vc-. <br /> SITE INFORMATION: AREA: StcQUADS E <br /> Parcel Owner's Name: , \ TYPE: \\W-lti(may <br /> Site Adams: ' FORMS: A")W �\ <br /> City,Vie,Zip Code: NOTES: <br /> Area Code -Teknftne Number <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: ie AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: R/W <br /> Area Code -Tellephone Number. RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby a ies for permission to excavate,construct and/or otherwise encroach on County Hiway Right-of-Way on the <br /> side QQf' AJA r.._. k),Q_ approximately qja (feet <br /> of YC by installing <br /> _Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> UVdt this project be sell-installed? 1 YES NO Contractor's License <br /> 1ePWGOV.ORG6SWEStCENf MSERVICEMERICAUPU&SV.WKWSTER.PSIENr.ROAo*AB T PEFUT DRNEWAY.DOC (10 9) Page 1 of 2 <br />