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COUNTY OF SAN JOAQUIN Date: ZT/!S //?- <br /> DEPARTMENT OF PULIC WORKS <br /> �" ( a�j3CoQ <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: o<1S �Z <br /> APPLICANT OFFICE USE ONLY <br /> Name: PYTi>v/ <br /> Address: L ,uR JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 0 c-s-+cnrl c-A e'S2v 5 APN fI f17-07o-iB FEE DUE: <br /> Area Code -Telephone Number _ EXP. DATE: DRIVEWAYS: <br /> A&k STREET: uJ,. [SCPA (/Wa <br /> SITE INFORMAT N: AREA: s4tk-_IG QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: , IJV V LS Uri W FORMS: 1 <br /> City, State,Zip Code: 97/-S NOTES: <br /> Area Code -Telephone Numbe . <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: X <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 Highway Right-of-Way on the <br /> 4- 5-7- side of G./14SO-1 4-wY approximately <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 /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10109) Page 1of2 <br />