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COUNTY OF SAN JOAQUIN Date: f`w <br /> DEPARTMENT OF PULIC WORKS 3 <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 1 <br /> APPLICANT OFFICE USE ONLY <br /> Name: /V /e A n c,1►e r;o I <br /> Address: 1157 Pe s f r' v z JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 14a,te e u CA 75 73 C APN 2zrg FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD ; <br /> Parcel Owner's Name: All lc +6e,,4141 n A-n TYPE: <br /> Site Address: 182.Z 0 Lq 1�-;p Rel FORMS: /? <br /> City,State,Zip Code: n, C,4 475T3 6 NOTES: <br /> Area Code -Telephone Number: Z ul-0-%,-i ue 75 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: 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 /> Sozl7hr side of approximately � e i+g &49-57- <br /> of <br /> t. Tof '41•s Al, ,by installing :Z�-,) <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> 'Vill this project be self-installed? YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />