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COUNTY OF SAN JOAQUIN Date: /d f/ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> -/ <br /> APPLICANT OFFICE USE ONLY <br /> Name: IC <br /> Address: % 0 Q t= R/ ;� 12� JOB#: 11005 ISSUE DATE: <br /> Ci ,State,zip Code: 121 APN �Z4`7-100-04, FEE DUE: <br /> Area Code -Telephone Number: 0-.7 i -/ r✓ EXP.DATE: DRIVEWAYS: <br /> STREET: 91✓zX6 RV # 00S�� <br /> SITE INFORMATION: AREA: AAfA 4 QUAD " <br /> Parcel Owner's Name: R7v-- v C- TYPE: 9 <br /> Site Address: Z ry o S- J . FORMS: ltJ X 17 <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: H( k�:; ( Co-tis-Fv,v c+C-7- AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RAN <br /> Area Code -Telephone Number. 2001 Lo i -aS6 1 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> e c�5 4 side of T-- 2`s Ys 2d approximately ?u o egthile ,,+1, <br /> of 17,`v I s f by installing A 3�2 �--•de ��cc aach,L.r d 'Ynel <br /> co Ad vcI,wrc%i c 0&1 4Ln -a` V c% ly <br /> Work will <br /> commence on or about IVO v i s+ for approximately Z days. <br /> SKETCH(Separate sheet may be submitted) <br /> �) w <br /> 1 <br /> � 30� <br /> 2C <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIAMSTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />