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COUNTY OF SAN JOAQUIN Date: G '4 -Zoll -2, <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGEk(� <br /> 0� Received By: <br /> PERMIT APPLICATION �/ CR#: d 14 6o< < <br /> APPLICANT OFFICE USE ONLY <br /> Name: ' <br /> Address: l% LSf^ JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: -IILT e o APN FEE DUE: <br /> Area Code -Telephone Number: Lc, o- lr V EXP.DATE: DRIVEWAYS: <br /> STREET: ( V,g <br /> SITE INFORMATION: AREA: S{C \`--\Ck, QUAD ia <br /> Parcel Owner's Name: TYPE: 17y\,\W— <br /> Site Address: 1 1 2-1 5, 0 I A ve, FORMS: S CrJ W \ <br /> City,State,Zip Code: '` -Te C.9-, "t NOTES: <br /> Area Code -Tele hone Number: Lv,N) Ll M- , G L1 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: 1-- AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @; <br /> 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 Count HlQ�hwa R' t-of-Wa on the <br /> side of Pe\� Ave <br /> Aapproximately (3U/ yeymi e <br /> of_ �C�� k 0 v,-- AV c 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 /> USJPWGOV.ORG\SHARES\CENTRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />