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COUNTY OF SAN JOAQUIN Date: AI – 1 ?- p 1 7 <br /> ' DEPARTMENT OF PULIC WORKS n ` <br /> DRIVEWAYS AND PAVED FRONTAGES Received By�G-Z <br /> PERMIT APPLICATION CR#:. G,-Z— <br /> APPLICANT OFFICE USE ONLY <br /> Name: E J. Ro css <br /> Address: p o gpX 2-3L4 JOB#: <br /> Cit , State,Zi Code: S f� 11005 ISSUE DATE: <br /> U�+vvz cq 9 5 2 1 3 APN t`1 q - <br /> Area Code -Telephone Number: -1 _ �{-�� _ 4 8 y EXP. DATE: --1 �a� FEE DUE: <br /> DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: 5t���p� QUAD S <br /> Parcel Owner's Name: 3 P2 J+DLL L-� c TYPE: <br /> Site Address: 3 3 s. Ot- V <br /> Cit , State,Zi Code: FORMS: PS <br /> 5 i"�� � G� 5 32B NOTES: <br /> Area Code -Telephone Number: 2vq• q ?v <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY <br /> Name: AGRICULTURE: WIDTHS <br /> Address: @FRONTAGE <br /> City, State,Zip Code: COMMERCIAL: <br /> Area Code -Telephone Number: INDUSTRIAL: @ R/W <br /> 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 Highway Right-of Way on the <br /> 045� side of `tk F� r� <br /> of approximately l e t/mile cS <br /> by installing <br /> commence on or about OG G 'Ls. for approximatelyS Work will <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? X_YES NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10/09) Pa eIof2 <br /> 9 <br />