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r COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: 15ye X z — <br /> Address: Q % C- e- - JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: ro G rz QS _ APN FEE DUE: <br /> Area Code -Telephone Number: yj_., 57 EXP.DATE: DRIVEWAYS: <br /> STREET: / <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 7 FORMS: <br /> City, State,Zip Code: ,o c #; ,4j��/s NOTES: <br /> Area Code -Telephone Number: (,2-qy 7 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: 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 hway Right-o-Way on the <br /> 4scvC-s7r side of Z!)Q,b /� g, approximately 6 e -Ae7 <br /> of&QJn/ '57- -, 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 /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />