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COUNTY OF SAN JOAQUIN <br /> Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: N71 �� <br /> APPLICANT OFFICE USE ONLY <br /> Name: c'(J - <br /> Address: #: 11005 ISSUE DATE: <br /> City,State,Zip Code: 4�t _ r JOB JOB <br /> Area Code -Telephone Number: APN -LG' t FEE DUE: <br /> "'r E' EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFO NIATION: AREA: , QUAD G <br /> Parcel Owner's Name: / TYPE: -�� <br /> Site Address: '� <br /> �� � FORMS: <br /> Cit , State,Zip Code: �;:�, NOTES: <br /> Area Code -Telephone Number: <- <br /> DRIVEWAY <br /> CONTR)T R 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 permissiqp to excavate construct and/or otherwise encroach on County Hi wa Ri ht-of-Wa on the <br /> side of approximately y g <br /> of T�r'.S' iL _,�' by installing <br /> commence on or about Work will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> 'C <br /> i <br /> I <br /> Will this project be self installed? YES NO Contractor's License �XQ� <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMENTPERMITDRIVEWAY.DOC (10109) Page lof2 <br />