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` v COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> ,4 Received By: <br /> ,.I 9�' DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: A/511 <br /> APPLICANT OFFICE USE ONLY <br /> Name: 5-6P— 1'/Vq"z S dY <br /> Address: P,6 V � 10/-/p^1 TJ JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: E� ,4/ �75S&CD APN 22?-6210- FEE DUE: <br /> Area Code -Telephone Number: $3 J/0'ell EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD 5,1:: <br /> Parcel Owner's Name: ',,V4 e TYPE: <br /> Site Address: FORMS: , <br /> City,State,Zip 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: @ RMI <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 encroach on County Hi hway Right-of-Way on the <br /> trT�� side of ,&Q approximately ee ile <br /> of �jCi4 ��� �� ,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 /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />