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UOUN I Y OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS —T <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: AkM <br /> APPLICANT OFFICE USE ONLY <br /> Name: !AW,—ktr ti 1'. �.ti" <br /> Address: Vo &, JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN jrJ FEE DUE: <br /> Area Code -Telephone Number: .3 L - J7 EXP.DATE: DRIVEWAYS: <br /> STREET: 90. * <br /> SITE INFORMATION: AREA: lioD/ QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: h. - FORMS: <br /> City,State,Zip Code: yk ►, NOTES: <br /> Area Code -Telephone Number:7 oci - y )q> I(�I y <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUA ITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: 3 COMMERCIAL: <br /> City,State,Zip Code: L-edl INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number:'Zatj 36C)I Zq/y 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 way Right-of-Way on the <br /> L► sideof --TJnav4 11d, approximately &' f mile EOf+ <br /> of d. by installing c e in i <br /> 1)CZ CIr'9' litltH >�; <br /> commence on or about 9- L l-I-L. for approximately /0 -6, 'r a days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> I <br /> I <br /> r <br /> GS 11d, ( �G )n1ht 1-tw �CIG+'dwft4yy . <br /> Z►�IUC' I <br /> 9.*-hJ4k1- Rd <br /> 1 <br /> ( <br /> h <br /> Will this project be self-installed? YES NO Contractor's License _ 6"I 73C. <br /> 11SRWGOV.ORGISHARESICEHTRALScRVICESICLERICALIPU&SV.VffMASTER.PSIEHCROACHMENTPERMITDRIVEWAY.DOC (10/D9) Page Iof2 <br />