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; �_ iLo3a93 COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS /ZZ/JZ <br /> DEP <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> APPLICANT <br /> Name: tic { L �� Zi2� i OFFICE USE ONLY <br /> Address: q3 7 f n ,� JOB#: <br /> Cit , State,Zip Code: c�;_-t—, S—� z APN 11005 ISSUE DATE: <br /> Area Code -Tele hone Number: ,,�, /��3—/2o—rv� FEE DUE: <br /> EXP. DATE: DRIVEWAYS: <br /> SITE INFORMATION: STREET: A::-!.I. * <br /> Parcel Owner's Name: ` AREA: L �p�c QUAD <br /> rZ�c� 7— <br /> Site Address: I I TYPE:��� <br /> Ci ,State,Lip Code: FORMS: <br /> CA NOTES: <br /> Area Code -Telephone Number: Lu.-i <br /> CONTRACTOR DRIVEWAY <br /> Name: ' TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: <br /> Address: AG <br /> v 2 � @FRONTAGE <br /> City, State,Zip Code:' UI2cz �, COMMERCIAL: <br /> Area Code -Telephone Number: INDUSTRIAL: @ RNU <br /> -` RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: <br /> Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Right of--Way on the <br /> spy / side of f ��f2/ ,�� <br /> of ��-�,G /Tl� approximately ��� <br /> by installing <br /> commence on or about Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES <br /> NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10/09) <br /> Page 1 of 2 <br />