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COUNTY 4F SAN JOAQUIN Date: /d 7 to <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name: b vI y,e, IR le— <br /> Address: a` 5 Co i {, ) -.a (z 0 JOB#: 11005 ISSUE DATE: <br /> ` <br /> City,State,Zip Code: z.zC) APN O2/_> 0_2 FEE DUE: <br /> Area Code -Telephone Number ao,;:'7 lflp 3 St ) EXP.DATE: DRIVEWAYS: <br /> STREET: Z,,f t r <br /> SITE INFORMATION: AREA: _.QUAD �E <br /> Parcel Owner's Name: A M y C4/U A b 14- TYPE: <br /> Site Address: AW 2,5zac:) dt41J RD. FORMS: <br /> City,State,OR Code. c eA P'5-Z4LO NOTES: <br /> Area Code -Tel hone Number: <br /> DRIVEWAY <br /> GONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State'Zip Code: INDUSTRIAL: MI <br /> R <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Righ -Way on the <br /> EA S _side of Z""" go approximately lyo �► ,r,� <br /> ofLGlEr2 �pD. ,by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Nil this project be self-installed? YES NO Contractor's License <br /> "SJPWGOV.ORGISWES%CENTRALSERVICEWLERICALVPUB-SH.WKWASTER_pS*NCROACHMENT PMW DRNEWAY.DOC (inn) Page 1 W 2 <br />