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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS �y <br /> Received By: G� <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: z�V7/2O <br /> APPLICANT OFFICE USE ONLY <br /> Name: /-/.P114 (� <br /> Address: k JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: C� - APN &�a'S/d6_Z/ FEE DUE: <br /> Area Code -Tele hone Number: ' EXP.DATE: DRIVEWAYS: <br /> STREET: y',r2 -Ve!,c 19p, <br /> SITE INFORMATION: AREA: QUAD i(/� <br /> Parcel Owner's Name: TYPE: <br /> Site Address: / FORMS: $� /✓w -I <br /> City, State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: VX <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach9n County Highwa fight-of-Way on the <br /> side of �*'Vi Ex- �?O, approximately / it <br /> of by installing �kl <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 <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />