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COUNTY OF SAN JOAQUIN Date: 2, 2- <br /> DEPARTMENT OF PULIC WORKS <br /> 6c 7- lk2s Received By: ' <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APP ANT OFFICE USE ONLY <br /> Name: / <br /> Address: / 'y/ JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: e, r APN 24 V,0-27 FEE DUE: <br /> Area Code -Telephone Number: 6 EXP. DATE: DRIVEWAYS: <br /> STREET: Y <br /> SITE INFORMATION: AREA: <br /> Parcel Owner's Name: 7 TYPE: <br /> Site Address: (�' ,` FORMS: <br /> Cit ,State,Zi ode: ( a'a-V 14,114 <br /> 9S—' 6 NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> ONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name:C ri e 0 2 See, AGRICULTURE: @FRONTAGE <br /> Address V" COMMERCIAL: <br /> City,State,Zip Code: ee,q. 0_A— 'I_C32 7 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 Coun:3e <br /> hway Right-of-Way on the <br /> otTTN side of L1,,�7��14L0 � approximately ria i}te�GcJEST <br /> ofi4 41A/ ,QJt , 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 /> Q5-12o2a I'I <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />