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COUNTY OF SAN JOAQUIN Date: 11 1'8- <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: z�w4a- <br /> APPLICANT OFFICE USE ONLY <br /> Name: 'O MA-(zk N <br /> Address: 6Z �" JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 5 ,q cls oc�j C 4 9 K2(D i APN = 9-SZ1 FEE DUE: <br /> Area Code -Telephone Number: p J EXP.DATE: DRIVEWAYS: <br /> STREET: ,�-j 0, <br /> SITE INFORMATION: AREA: QUAD Al <br /> Parcel Owner's Name: c- r ,&Z-. —o N TYPE: <br /> Site Address: 2,-S I ,�;- " 1- -e-+ FORMS: A'w <br /> City,State,Zip Code: A M ?O C-A- NOTES: <br /> Area Code -Telephone Number: po Z <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encrpp��cch on County High wa Right-of-Way on the <br /> s <br /> 3-' side of ���sr'�n/ ,��� approximately Vis- <br /> of by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 o12 <br />