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? COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By:Q2��: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION 2 2 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: s t J B#: 11005 ISSUE DATE: <br /> City, State,Zip Code: ti APN 7Gt a(� FEE DUE: 2 3S. <br /> Area Code -Telephone Number: ;"7 � ]l- EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: 7 V„r,.r_SC� QUADS VJ <br /> Parcel Owner's Name: _ L ;,F TYPE: —0tr�\U�Q <br /> Site Address: .J1 � FORMS: -as l�.) I <br /> City,State,Zip Code: C, 0 NOTES: <br /> Area Code -Telephone Number: 12C <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> Name: ' <br /> Address: I . cL, -Y liLU COMMERCIAL: <br /> City,State,Zip Code: -t INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: _c_�)c' 7 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to ccavate construct and/or otherwise encroach on County Highway Ri ht-of-Way on the <br /> side of approximately I,?00 feet/mile <br /> N U�,Y �Fly L� e c�.� 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 :rt nO;;; <br /> Zb <br /> IkSJPWGOV.ORGVSHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />