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COUNTY OF SAN JOAQUIN Date: 5 �z <br /> P <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: D �� <br /> APPLICANT OFFICE USE ONLY <br /> Name: ilm t r <br /> Address: CLC, JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: 1 1 APN 24�--►70— FEE DUE: <br /> Area Code -Telephone Number{ �j" EXP.DATE: DRIVEWAYS: <br /> STREET: �'fGHE1/6QJ� <br /> SITE INFORMATION: AREA: Ya¢' QUAD <br /> Parcel Owner's Name: Lt�C� r TYPE: <br /> Site Address: FORMS: -/7 y✓ <br /> City,State,Zi Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <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 enc ach on County Hi ay Right-of-Way on the <br /> "de of �7-Gfi�e/Eie�/ 9� approximately bV fee ile <br /> of by installing <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 /> 11SJPWGOV.ORG\SHARES\CENTRALSERVICES\CLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />