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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> PS- 14 Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: bd67/b <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: G�,-7 1 of 0 � JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: j C' APN 070-/2o-/O FEE DUE: <br /> Area Code -Tele one Number: C;c _ �� EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> te <br /> ITE INFORMATION: AREA: 57����`ral+,/ QUAD <br /> Parcee: TYPE: <br /> ' Site Ar f� c FORMS: <br /> Cit ,S : p NOTES: <br /> Area Cone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: WIDTHS <br /> AddreCOMMERCIAL: <br /> City, S : INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: X <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 High Righ:of-Way on the <br /> ei4 sT" side of =-L.1e,ZloeN Z)A. approximately 2 70 p <br /> of 7,bti� /l/jsTGs�E�/ by installing td�y✓ `/°,�D <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> I�crrC <br /> Will this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />