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COUNTY OF SAN JOAQUIN Date: 8e /2 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: Gni 653 7 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: )y (,q 35-) APN o?p_O FEE DUE: <br /> Area Code -Telephone Number: Z-(jc - - , 3�- EXP. DATE: DRIVEWAYS: <br /> STREET: 14eD. <br /> SITE INF RMATION: AREA: QUAD <br /> Parcel Owner's Name: L 2 TYPE: <br /> Site Address: lai'99 1, FORMS: <br /> City,State,Zip Code: /j 0,A. 9,- NOTES: <br /> Area Code -Telephone Number: Zze-/ ~�z� <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: ba— 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 ay Riay ght-of-Won the <br /> A&&',1Z1 side of ES ,D. 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? V-' YES _ NO Contractor's License elL-IgPjn ,/8,),-1 <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTE,R.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />