Laserfiche WebLink
COUNTY OF SAN JOAQUIN Date: _2- S -2 b E <br /> DEPARTMENT(3F PULIC WORKS j5 ` <br /> PJ6&A�0��ceived By:(- eJC,`; ► <br /> DRIVEWAYS AM PAS FRONTAGES <br /> PERMIT APPLICATION CR#: 2, <br /> APPLICANT OFFICE USE ONLY <br /> Name: E' <br /> Address: 4QL40 L. !RX JOB#: 11005 ISSUE DATE: <br /> city State, ' Code: -5 APN C ' ,FEE DUE: <br /> Area Code -T Nber -66 EXP.DATE: DRIVEWAYS: <br /> STREET: Arf-M)Afflaw tA <br /> SITE INFORMATION: AREA: C[� l Aft" QIJAD tj E <br /> Parcel Owner's Name: &K.4 I�c t 1tr TYPE: , <br /> Site Address: FORMS: 5 <br /> City,State,ZipCode: -t5 NOTES: <br /> Area Code -Telephone Number 1 Z — &o r Es' <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: All -- AGRICULTURE: @FRONTAGE <br /> Address: 80 COMMERCIAL: <br /> City,State,Zip Code: E(e f S NDUSTRIAL: @RM <br /> Area Code -TNumber ,g RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for to excavate,construct and/or otherwise enc r ach on County H Right;of Way on the <br /> A side of pock I `e l C�. approximately / - A[64cr44 <br /> of '_,rte by insta ft <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> ,J <br /> Will this project be se#f-installed? _YES NO Contractor's license 5Z-7 ?C, l <br /> =PWGW.ORG1 WZES1CSMALxEMMS%MERICALFUI3 sW MKVMwn3LPSBCRDAO*M9'n PEW M&VAY.DOC (IM Page 1 of 2 <br />