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COUNTY OF SAN JOAQUIN Date: 41 Cl <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES 2 <br /> PERMIT APPLICATION CR#: G 3a(OJ <br /> APPLICANT OFFICE USE ONLY <br /> Name: 61 <br /> yzc <br /> Address: P day 3l 1 JOB#: 11005 _ ISSUE DATE: <br /> City,State,Zi Code: c f C ,2 APN &7-ad-1 FEE DUE: <br /> Area Code -Telephone Number: a?v q X36 r--2-1/ EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD AVE. <br /> Parcel Owner's Name: CT&rya TYPE: <br /> Site Address: 176 0/ A) E u K FORMS: 1)17 <br /> City,State,Zip Code: Ccc, S-Za v NOTES: <br /> Area Code -Tele hone Numb r. o� t/ -/.3)(J <br /> DRIVEWAY <br /> CONTRACTOR TYPE: ANTITY WIDTHS <br /> Name: t-ter /{ E 27-/,c AGRICULTURE: J FRONTAGE <br /> Address: C 3 COMMERCIAL: <br /> City,State,Zip Code: CC,' ){ 4/2 INDUSTRIAL: R!W <br /> Area Code -Tele hone Number: v ` _,;z r/ RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appkes for permiss)on to excavate,construct and/or otherwise encroach on County Highway Rigght-of-Wa on the <br /> S 4" side of r,5 t� c approximately IST feegVmile <br /> by installing <br /> XC6ccc -> C C�� op� c C0 lc- (�C 6 U' <br /> CICN <br /> Le. SCi <br /> commence on or about for approximately �2 0 days. Work will <br /> SKETCH(Separate sheet may be submitted') <br /> C <br /> Will this project be self-installed? YES NO Contractor's License 6122130 <br /> N.CENTRALSERVICESICLERICALWUBSV.WKIMASTER.PSIENCROACHMENTPERMTDRIVEWAY.DOC (01M8) Paget oft <br />