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COUNTY OF SAN JOAQUIN Date: /© <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: 6,q g <br /> APPLICANT OFFICE USE ONLY <br /> Name: C <br /> Addrew 3900 JOB#: 11005 ISSUE DATE: <br /> Staie,Zip Code: X153 Sly APN 06-1-166-3 I FEE DUE: <br /> Area Cade -Telephm Number. EXP.DATE: DRIVEWAYS: <br /> STREET: AO-t k <br /> SITE INFORMATION: AREA: �aC ,-t QUADSte_ <br /> Parcel Owner`s Name; 0bo TYPE: we_(,Je4 <br /> Sale Address. �' f3r� FORMS: (,,) <br /> Sw Cute: 4AV_W R 6 NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: C AGRICULTURE: @FRONTAGE <br /> Address: ,636 COAAMERCIAL: <br /> city,state,Zip Code:momgrb 69 qS3S7-7 INDUSTRIAL: RNV <br /> Area Code -'T Number: S- 5W'7 RESIDENCE: <br /> 6411 ro,- P/'c t, ) �Z� >�! -O �y PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for pin to excavate,construct and/or otherwise encroach on County Highway Ri ht-of-Way on the <br /> side of N, AP '23Ao approximately J i feet/ fe � <br /> Of C.N3"..tZpity:9 ,by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> VM this project be self-installed? YES NO Contractor's License <br /> 11SJPWGOV.OR61SWREMENnM-I;EfMMSQERtC&PU M.WKWIASTER.P$eXROACFMENT PERMR DRNEWAY.DOC (1W9) Page 1 of 2 <br />