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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS /� �Received Byt" J� <br /> K RIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:(-�C4 7 C,, Ca <br /> AP LIE NT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: CG,vl'k 2 2 -D APN �}(��z b- FEE DUE: <br /> Area Code -Telephone Number: p 05-1-4 EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> � yr� E_ <br /> ParcelOwner's Name: vk✓) '& 1\� IN, 03 TYPE: <br /> Site Address: 1 6A L— . A FORMS: <br /> City, State,Zip Code: ,S--\ CA ZD NOTES: <br /> Area Code -Telephone Number: 6 `- 6j. <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: VAJAGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: ` <br /> City,State,Zip Code: ots t) INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The u�nr1dersigned hereby applies for permission to e c vate,construct and/or otherwise�croach on County Highway Right-of-Way on the <br /> side of J approximately CYJ e mile "` <br /> of by installi g <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) Pagel of 2 <br />