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COUNTY OF SAN JOAQUIN Date: /2 Y <br /> ` DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By; <br /> PERMIT APPLICATION CR#: J6&14K <br /> APPLICANT OFFICE USE ONLY <br /> EAema <br /> ick Noc-c�l <br /> s: 133 y2 G /\V AS F,CAO JOB#: 11005 ISSUE DATE: <br /> ate,Zi Code: �"1,nN i_CA C/-1 ��� ; (U APN FEE DUE: <br /> ode -Tele hone Number. (Zc c;) >=qCc - (--zc,j EXP. DATE: 17 DRIVEWAYS: <br /> STREET: 9. * <br /> SITE INFORMATION: AREA: A QUAD <br /> kParcel Owner's Name: r7l7l IC }J6�N TYPE: <br /> Address: )3qc)q E RqV � I i'O/A D FORMS: h/ 17, State,Zi Code: MAS)ECA CA 330 NOTES: <br /> Area Code -Telephone Number: NJA <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> Cit ,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 f r permission to excavate,construct and/or otherwise encroach on County Hi ay Right-of-Way on the <br /> r1Ti� side of ✓Eapproximately 2-4�,b fe <br /> Of Z?). by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES _ NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.I'SIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />