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COUNTY OF SAN JOAQUIN Date: !v� <br /> DEPARTMENT OF PULIC WORKS <br /> l( DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: a w a =ML` <br /> Address: 3 v JOB#: 11005 ISSUE DATE: <br /> City, ate,Zip Code: me C APN FEE DUE: <br /> I Area Code -Telephone Numb r. (ol6.. Sao ' EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD/ <br /> Parcel Owner's Name:0E ME;Y' C no P L L c. TYPE: <br /> Site Address: 3b IT. rc,c 1 t, . FORMS: S <br /> City,State,Zip Code: C NOTES: <br /> Area Code -Tele hone Numb _ o0 <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 /> Th undersi ned hereby applies for permission oexc vate,construct and/or otherwise encroach on County High (ght-of-Way on the <br /> side of r approximately n , 3 fee ile <br /> of by installing <br /> e 1"�,t>ce-1 0 c C 2 c C>U eVV <br /> n. <br /> . r <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> C 4 -Pe—la <br /> Will this project be self-installed? 74YES _ NO Contractor's License <br /> %S"GOV.ORG)SHARESICENTRALSERVICESICLERICAL%PU&SV.WKVAASTER.PSIENCROACHMENT PERMR DRIVEWAY.DOC (10109) Page 1 o12 <br />