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COUNTY OF SAN JOAQUIN Date: '�r <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> _— <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name: f- v704 <br /> Address: 1 p'Ja Ca tu,ic JOB#: 11005 ISSUE DATE: <br /> City,State,Tip Code: 5+mj `t S 3X!S APN FEE DUE: <br /> Area Code -Telephone Number: _�o .- q3 i-�l 6,571 EXP.DATE: DRIVEWAYS: <br /> STREET: '"-'—E22 p'I7. <br /> SITE INFORMATION: AREA: QUAD NE ' <br /> Parcel Owner's Name: 3,,Arxta r z,K,., - TYPE: <br /> Site Address: `SEE;� R J FORMS: �%✓�t!; ,� ; <br /> City,State,Zip Code: stLhj �,a NOTES: <br /> Area Code -Telephone Number: 3 i-Z 6 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: Tom S lei�:­ ' i c }rN, AGRICULTURE: @FRONTAGE <br /> Address: _ COMMERCIAL: <br /> City,State,Zi Code: INDUSTRIAL: RNV <br /> Area Code -Telephone Number: X. - i ,F-. S 1 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Th undersigned hereby applies for pe is�ion to excavate,construct and/or otherwise encroach on County Highway y Right-of-Way on the <br /> side of 2Z approximately i 200 ln}ecr�t� <br /> of by installing <br /> Work will <br /> commence on or about _ for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License y 7 c*J <br /> M10ENTRALSERVICESICLERICALWUBSV.WKIMASTER.PSIENCROACHMENT PERMIT URNEWAY.DOC (O/08} Page 1 of 2 <br />