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UUUN I Y 01- SAN JOAQUIN Date: 2-/��Z— <br /> ,�� DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: G �3SI <br /> APPLICANT OFFICE USE ONLY <br /> Name: `J <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN pJ—o3b—SC , FEE DUE: <br /> Area Code -Telephone Number: 53o--o?7.8 - ! I EXP.DATE: DRIVEWAYS: <br /> STREET: 2o. * <br /> SITE INFORMATION: AREA: ,lto QUAD X&5 <br /> Parcel Owner's Name: ^ Q !' i I C�— TYPE: <br /> Site Address: ( l,'e- FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: Yb g c2`73 <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 encroach on County Hiih�hway Right-of-Way on the <br /> A/o eTN side of 84dG E�' �oAJ> approximately �(2P4P e rr1 EAST' <br /> of l�11.97 1iSlSo�t/ ,tea. AGA/yli� by installing ZWI*15� <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.WKIMASTE.R.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10109) Page Iof2 <br />