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' COUNTY OF SAN JOAQUIN Date: ' ? - j. <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#:_-S t/sG <br /> APPLICANT <br /> Name: f , �-w �,,� u t -,�; ;,,} OFFICE USE ONLY <br /> L./ <br /> Address: Po b� 7 rB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: �- J7 <br /> Area Code -Tele hone Number: .. _ d� 21 o FEE DUE: <br /> e, �., - S�."F ".� EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: -® QUAD Aj�_4 <br /> Parcel Owner's Name: hLy� ;.� �f- TYPE: <br /> Site Address: / '`lam / ,�.c o c �,( FORMS: <br /> City, State,Zip Code: ¢�,c_. syr C y - NOTES: <br /> Area Code -Telephone Number: <br /> CONTRACTOR , DRIVEWAY <br /> TYPE: QUANTITY WIDTHS <br /> Name: J�«± (nom Lc`S p��tc-t� C� ", AGRICULTURE: <br /> FRONTAGE <br /> Address: f � ,� 7 6Q- COMMERCIAL: <br /> City, State,Zip Code: i�-t 0 e es;,t,�.% INDUSTRIAL: <br /> Area Code -Tele hone Number. C'_ RNV <br /> _ 5 S- RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> To under igned hereby Tap lies for perm' sio�o excava�`cpnstruct and/or otherwise encroach on County H' hway Rig hof-Way n the <br /> -x�Zc,, side of '�-; , AA <br /> r, approximately 1�6 Li feetll/nile <br /> by installing <br /> ------------------ <br /> Ow <br /> 2 C� c c <br /> commence on or about Work will <br /> - for approximately ,�(� days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License y�i s � . <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWIASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />