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COUNTY OF SAN JOAQUIN Date: lv•- 11Z —2Gt Z <br /> DEPARTMENT OF PULIC WORKS n \ <br /> Received By: O�G-�_ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:(2::, <br /> APPLICANT OFFICE USE ONLY <br /> Name: " +✓ c�\ l``i `�: <br /> Address: �; JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: c �,� ( � q S7 r{ APN FEE DUE: <br /> Area Code Tele hone Number: 7v-2 46.3 EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: L�jp � QUAD <br /> Parcel Owner's Name: Sc, };L� ,�,C cu • ; TYPE: <br /> Site Address: . rVo FORMS: • b(,J 29 mac, E'139 <br /> City,State,Zi Code: �• Cy �Z�! NOTES: _ f <br /> Area Code -Telephone Number: 707 L2 3 i0 - <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: ` f L( =L1- ,l l% ,t, L+2' 'ZC% AGRICULTURE: <br /> Address: 5`3 Z Sri LA Ili& LU` t @FRONTAGE <br /> COMMERCIAL: <br /> City, State,Zip Code: _S ;U\pq.-(ZL1S4 C vV INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number. c7 �-A -1`7 Z'2 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: 7 Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hiway Right-of-Way on the <br /> side ofA, / r �_approximately Z C �C> ` e tfmile � 2TN <br /> Of ZvU�� / <br /> byinstalling <br /> commence on or about 1 V/L for approximately days. Work will <br /> SKETCH (Separate sheet may be submitted) <br /> +T�) �i�//z <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 />