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COUNTY OF SAN JOAQUIN Date: LI-2 v(z- <br /> _ DEPARTMENT OF PULIC WORKS <br /> Received By�""' <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION ��� CR#:(2) Lt 6G6_5 <br /> APPLICANT OFFICE USE ONLY <br /> Name: J19 n1 ES LJ , 1 7 c <br /> Address: Fb A 0 1' / g c 3 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: s C- •j a C4 95 8( APN j S- /SO FEE DUE: <br /> Area Code -Telephone Number: b - 1 — EXP.DATE: DRIVEWAYS: <br /> STREET: UlA-Y I e I &he_ <br /> SITE INFORMATION: AREA: S-FaC_�<{�! QUAD wS <br /> Parcel Owner's Name: TYPE: Ov t V e k OC—\ <br /> Site Address: 1 ' L M 0 P', CL d FORMS: 5 <br /> City, State,Zip Code: S NOTES: <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 Hi hway Ri ht-of-Way on the <br /> JLi <br /> sideof UukN IeIA_ EUP. approximately .2 feeUmile LC+t.1 <br /> of r,w VAA iAt�- \,o 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 /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page i of 2 <br />