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COUNTY OF SAN JOAQUIN Date: _� v <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: Q� <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City, State, APN r8/-O9$ /5 FEE DUE: <br /> Area Code -Telephone Number: EXP. DATE: DRIVEWAYS: <br /> STREET: W&P`259 Ap <br /> SITE INFORMATION: AREA: fir QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: j 2 F ,? FORMS: <br /> City, State,Zip Code: 0' S .n NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: 14or ,, Yb" 5 4v Kdt1-0- AGRICULTURE: <br /> Address: a @FRONTAGE <br /> P d COMMERCIAL: <br /> City, State,Zip Code: �� , © Cy L" INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: ;;2�c�c Q/. GZ,42 RESIDENCE: <br /> PAVED FRONTAGE <br /> / LENGTH: Ft. X WIDTH: Ft. <br /> The,uersigned hereby applies or permission to excavate,construct and/or otherwise enc ach on County Highway Right-of-Way on the <br /> o �1 side of oo approximately 00 feet/mile 4� <br /> of 7P,/e-��UE lam, by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> 0 <br /> f <br /> A A <br /> Will this project be self-installed? YES _ NO Contractor's License '5 7 6 S� `1 <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTEPLPSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />