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l <br /> COUNTY OF SAN JOAQUIN Date: <br /> . 1 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: LA, !7 <br /> Address: r ' y` ✓, �1(; ,;,� ;�(�� r7 JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: f�- APN ?��''3�a O$ FEE DUE: <br /> Area Code -Telephone Number:( Z r cr) c l,�- ( ( � AXP. DATE: DRIVEWAYS: <br /> STREET: '55�x�_ 6e 2r' go <br /> SITE INFORMATION: AREA: QUAD $ <br /> Parcel Owner's Name: TYPE: <br /> Site Address: w .l ,�h j— Z,- FORMS: ,f <br /> City, State,Zip Code: ('v cc C. �l '/' NOTES: <br /> Area Code -Telephone Num er: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @RNV <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 way Right-of-Way on the <br /> .c/O side of T, 14/ ' O f��°�Gy,QD. approximately 2� <br /> of 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 /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />