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COUNTY OF SAN JOAQUIN Date: /BlL <br /> DEPARTMENT OF PULIC WORKS <br /> -(2-0tsgz. <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: 4!�O3h4 <br /> APPLICANT OFFICE USE ONLY <br /> 1251311,-i wA <br /> 's: P % '�-'� L %b - JOB#: 11005 ISSUE DATE: <br /> tate,Zip Code: 5 fpc -, yoy >1 GQ �ISZo1 -I 916 APN i32-D'70-o I FEE DUE: <br /> :ode -Telephone Number: �q -4(,,1-q I 5-1: EXP. DATE: DRIVEWAYS: <br /> STREET: iA)A <br /> SITE INFORMATION: AREA: SToc,t�-j�AJ QUAD <br /> Owner's Name: TYPE: �L <br /> 'dress: 61A41 FORMS: <br /> ate,Zip Code: NOTES: <br /> ode -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> COMMERCIAL: <br /> ate,Zip Code: INDUSTRIAL: @ R/W <br /> )de -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hw Right-of-Wa on the <br /> 94S side of LcJ 1613cno I ��9 y approximately L p� <br /> b,vF�F� GA M9 L &v <br /> by installing <br /> nence on or about for approximately days. Work will <br /> :TCH(Separate sheet may be submitted) <br /> 3 project be self-installed? YES NO Contractor's License <br /> '.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWIASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />