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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: S� <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> � — <br /> L `� i JOB#: 11005 ISSUE DATE: <br /> ate,Zip Code: � \ , APN OSS-2S0-3S' FEE DUE: <br /> )de -Telephone Number:-(:-�C _ ` , Lj pE2 EXP. DATE: DRIVEWAYS: <br /> STREET: �,L/j�/GpQ,y X,0O <br /> SITE INFORMATION: AREA: of QUAD <br /> )wner's Name: 1 L IT TYPE:/ <br /> 'ress: L 0 D \ G ) FORMS: <br /> te,Zip Code: NOTES: <br /> de -Telephone Numbe <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> COMMERCIAL: <br /> e,Zip Code: INDUSTRIAL: @ R/W <br /> le -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> idersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of approximately ee <br /> by installing ,��✓ <br /> Work will <br /> :nce on or about for approximately days. <br /> CH(Separate sheet may be submitted) <br /> Project be self-installed? YES NO Contractor's License <br /> GISHARESICENTRALSERVICESICLERICALIPUB-SV.WKVMASTER.PSVENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />