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COUNTY OF SAN JOAQUIN Date: q -3 -2b12- <br /> ,�_ DEPARTMENT OF PULIC WORKS <br /> � <br /> DRIVEWAYS AND PAVED FRONTAGES Received By; <br /> PERMIT APPLICATION CR#:_ CD y,S 63 Z <br /> A PLICANT OFFICE USE ONLY <br /> Address:- 2 1, JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: %_ APN 1'11, zvp - I Z FEE DUE: <br /> Area Code -Telephone Number: (` ] - EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: S�c�h}c�v� QUAD <br /> �P,a�rcelOwnl( r'sName: �/ TYPE:te Address: p C� ,� FORMS: S5�w ,�� �-t <br /> Cit ,State,Zi Code: �; NOTES: fr <br /> Area Code -Telephone Number: �� <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 Highway Right-of-Way on the <br /> U side of approximately 20o feet/mile ff&3-� — <br /> of SE. by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES _ NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.I'SIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />