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COUNTY OF SAN JOAQUIN Date:
<br /> DEPARTMENT OF PULIC WORKS
<br /> Received By:
<br /> DRIVEWAYS AND PAVED FRONTAGES
<br /> PERMIT APPLICATION CR#:
<br /> Name: urAPPLICANT OFFICE USE ONLY
<br /> 9
<br /> ✓r,cl Crr t�1'`.r� 4111c
<br /> Address: g,7-SU N l� � c
<br /> 4 er .,, _ !'.i, JOB#: 11005 ISSUE DATE:
<br /> City,State,Zip Code: APN la FEE DUE:
<br /> Area Code -Telephone Number.` ,? q agog EXP.DATE: DRIVEWAYS:
<br /> STREET: 1� ,tt°/ _✓a�1�.�#� ,
<br /> SITE INFORMATION: AREA: QUAD//1,4>
<br /> Parcel Owners Name: TYPE:
<br /> Site Address: > n.> �� ,,�� FORMS: 6/.�-
<br /> City,State,Zip Code: NOTES:
<br /> Area Code -Telephone Number:
<br /> DRIVEWAY
<br /> CONTRACTOR TYPE: QUANTITY WIDTHS
<br /> Name: �,' ,,<</ - r,;;:;;1 ,,, p @,' AGRICULTURE: @FRONTAGE
<br /> Address: /=; ,r.,,,.;., +' / COMMERCIAL: X
<br /> City,State,Zi Code:;,,a r ,. a -"4 INDUSTRIAL: R/W
<br /> Area Code -Tele hone Number:e9_,==„ ,x o>> RESIDENCE:
<br /> PAVED FRONTAGE
<br /> LENGTH: Ft. X WIDTH: Ft.
<br /> The undersigned hereby applies for permission to exc vate,construct and/or otherwise encroach on County Highway Right-of-Way on the
<br /> z-,,,•. side of Low, -!:A R approximately /707 ee mile
<br /> of n, d.6^ op WWI by installing a A^,,,/ b <see^
<br /> ir, AL,141
<br /> C ro,.•-,a, �t� tsr.z>, a'rn t C n C.�"� W i� �f�OL.t�
<br /> �c D rsan/i -C6, . r rr �:rry r c'•,
<br /> l.J P6nCln7� A, is
<br /> Work will
<br /> commence on or about for approximately f days.
<br /> SKETCH(Separate sheet may be submitted)
<br /> Will this project be self-installed? YES NO Contractor's License
<br /> M:ICENTRALSERVICESICLERICALIPUBSV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (01108) Page 1 of 2
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