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t <br /> COUNTY OF SAN JOAQUIN Date: d,/-<-// <br /> DEPARTMENT OF PULIC WORKS !` ,/ <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: Gf- . z9l o <br /> APPLICA T OFFICE USE ONLY <br /> Name: <br /> Address 12�0 A JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN J FEE DUE: <br /> Area Code -Telephone Number: hoc / EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: eV 5 lM©S TYPE: <br /> Site Address: 35-3 FORMS: <br /> City,State,Zip Code: NOTES: f <br /> Area Code -Telephone Num er: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <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 encr ach on County HighwaRight-of-Way on the <br /> filo.PS side of LQ'liSE fi�l'� approximately it <br /> of �.iJ /(!6Q ,�L� 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 /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />