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COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PULIC WORKS ' ° �'�f5 <br /> DRIVEWAYS AND PAVED ! t� R��gy. <br /> PERMIT APPLICATION ES <br /> APPLICANT <br /> Name: I��NADO&s I g OFFICE USE ONLY <br /> Address: L RSR <br /> .3 + toe <br /> Ci ,State,Zi Code: ; _ hS , C:+ '7 S 2v 10f ISSUE DATE: <br /> Area Cod_Iephone Number`z�,g I 'te z!g 5 APN FEE DILE: <br /> EXP.DATE: DRIVEWAYS: <br /> SIT INFORMATION: STREET: <br /> Parcel Owner's Name: % -�� � AREA: �__ a.�_,1 ,____---- <br /> QUAD <br /> Site Address: �Gc= 4-1- ;f-c st 5 TYPE. <br /> Ci ,State,Zi Code: FORMS: S <br /> r NOTES: <br /> Area Code -Telephone Number: zCq _T <br /> x <br /> CONTRACTOR DRIVEWAY <br /> Name: 15 �' ,A% TYPE: QUANTITY <br /> Address: ' 6, -t E: WIDTHSCi ,State,Zi Code: =:v G COMMERCIAL: �A <br /> Area Code -Tele hone Number rte;-� � INDUSTRIAL- <br /> RESIDENCE: # W <br /> LENGTH: PAVED FRONTAGE <br /> Ft X WIDTH: Ft <br /> Th 4dersigned hereby applies for permission to exr,;4 construct and/or otherwise encroach on Coun <br /> T side of V�"t�..;:.�, 4 ���. ty <br /> of .�7h L uc u,� - j approximately W a h — cZFLU <br /> - 'Way on the <br /> h.J, <br /> commence on or about <br /> for approximately Work wrt� <br /> SKETCH(Separate sheet may be submitted} days. <br /> Will this project be self-installed? <br /> -YES NO Contractor's License 0.3 4 , - <br /> WS'WGOV.ORG*SyARES�CENTRALSERVICESICLERICALIpUg.SVWK'A4ASTEFI.PS1ENCROACHMENTPERMITDRWEWAY.DOC (1=9) <br /> Page i oft <br />