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COUNTY OF SAN JOAQUIN Date: f� <br /> - —►t 004?5 DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received BY: ——` <br /> PERMIT APPLICATION CP4: ?61 <br /> AP,LICANT <br /> Name: OFFICE USE ONLY <br /> �; <br /> Address: JOB#: 1005 <br /> Ci ,State,Zip Code: • j �; c i ISSUE DATE: <br /> Area Code --Telephone Number• ->,.o r� 44 APN f__,.,p�� FEE DUE: <br /> ` EXP.DATE: DRIVEWAYS: <br /> SITE INFORMATI N: �'90 STREET: „ <br /> Parcel Owner's Name: , L, f AREA: , GJS <br /> Site Address: -- G.nw�_ TYPE: <br /> Ci ,State,Zi Code: <br /> Area Code -Tele hone Number: NOTES: <br /> DRIVEWAY <br /> CONTRACTOR IRESIDEtNGE: <br /> QUANTITY <br /> Name: E: W#DTNS <br /> Address: L: NAGE <br /> City,State,Zi Code: <br /> Area Code -Telephone Number: <br /> PAVED FRONTAD <br /> LENGTH: Ft X MUTH FL <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach <br /> side or City Midway <br /> of lG/A _approximately # <br /> Alr�, on ft <br /> -- � _�y installing Gt <br /> commence on or about a Work wig <br /> for approximately "3 days <br /> SKETCH(Separate sheet may be submitted) <br /> ei 1 <br /> eb <br /> Will this project be self-installed? <br /> YES NO Contractor's License <br /> ""'WGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCRGACHMENTPERMITORIVEWAy.DOC (100) Page Iof2 <br />