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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> APPLICANT <br /> Name: OFFICE USE ONLY <br /> Address: C) 6"_-� & JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: C 0 E. APN FEE DUE: <br /> Area Code -Telephone Number: 2�!� 4 6 2- -7 EXP.DATE: DRIVEWAYS: <br /> C"kk STREET: <br /> SITE INFORMATION:,C,,%, rjc_(, AREA: L k 6A e- QUAD <br /> Parcel Owners Name: TYPE: '2 <br /> Site Address: FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: 2-C,cl cl_'2 --- <br /> �SL I'-; <br /> DRIVEWAY <br /> Name: CONTRACTOR TYPE:_- QUANTITY WIDTHS <br /> Address: AGRICULTURE: NTAGE <br /> COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on the <br /> tv c,­D4 side of approximately* .1 1� _feeZileEA--,- <br /> of <br /> 7F2- ,by installing 1 -7' <br /> A=7 i-C A- L 71 <br /> commence on or about - for approximately Work will <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? -YES NO Contractor's License <br /> \\SJPWGOV.ORGISHARESICENTRAL'.ERVICESICLERICALIPUB-SV-WKWAS-FER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />