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COUNTY OF SAN JOAQUIN Date: 1!0 2 <br /> - DEPARTMENT OF PULIC WORKS <br /> ` 12��38 Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name:..- -Se n i� <br /> Address: ;;_r �� ! JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: 7 f, %�', APN pj�� _ ,¢ FEE DUE: <br /> Area Code -Telephone Number: o7d'�t-fij__ ,5Z EXP. DATE: DRIVEWAYS: <br /> Gyrli6 yr <br /> SITE INFORMATION: STREET: <br /> AREA: �j�n�pJ QUAD Il <br /> Parcel Owner's Name: ��� gra ,� r Zd <br /> TYPE: /!/EhlI4 <br /> Site Address: FORMS: <br /> Cit , State,Zi Code: > ; ; �� <' NOTES: <br /> Area Code -Tele hone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: I @FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: INDUSTRIAL: I @ R/W <br /> Area Code -Telephone Number: RESIDENCE: yC <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 hway Right-of-Way on the <br /> side of "IAI!5 ��•jT approximately 7S � <br /> of 1��t/,e� �I: _ lyacr�g,7,�66 ,by installing <br /> commence on or aboutfor Work will <br /> 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 (10109) Page 1 of 2 <br />