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COUNTY OF SAN JOAQUIN Date: /0,2/-26 L� <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 4 L4 1 r� <br /> - ' <br /> APPLICANT OFFICE USE ONLY <br /> Name: ,1 <br /> Address: 1 Lc n . " JOB#: 11005 ISSUE DATE: <br /> City,Sta Zip Code: r G APN OG j_ __L- <br /> J_ FEE DUE: <br /> Area Code -Telephone Number: 1 — y EXP.DATE: DRIVEWAYS: <br /> STREET: (,elks <br /> SITE INFORMATION: AREA: L-0(3-1 QUAD <br /> Parcel Owner's Name: TYPE: k t v <br /> Site Address: 1 i FORMS: S (,'� <br /> City,State,Zi Code: L NOTES: <br /> Area Code -Telephone Number: " <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 encroach on County Highway Right-of-Way on the <br /> P,S4- side of t a�a``.� !_ —-� approximately [ .� fee"A- <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.ORG\SHARESICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />